Progress of the operation
Through a suprapubic incision or laparoscopic punctures, the diverticulum is isolated from the outside from the surrounding tissues (if located next to the ureter, a stent is first installed in it), cut off at the neck, and the bladder wall defect is sutured with a double-row suture. If the ureteral orifice is involved in a diverticulum, ureteral reimplantation is performed. The prostate adenoma is removed during the same hospitalization - openly or endoscopically. The catheter lasts 5–7 days, the drainage lasts 2–3 days. The removed diverticulum is examined histologically. Relapses after complete excision practically do not occur.
What is a diverticulum and why is it dangerous?
A diverticulum is a sac-like protrusion of the bladder wall, congenital or acquired due to prolonged difficulty urinating (adenoma, stricture, neurogenic bladder). Urine stagnates in the diverticulum, stones form, a chronic infection develops and, in 2–5%, a tumor, since its mucous membrane is constantly irritated. Indications for surgery: residual urine, recurrent infections, stones, tumor, ureteral compression.
Operation selection
For a small diverticulum with a narrow neck, endoscopic dissection of the neck is sufficient - the diverticulum begins to empty along with the bladder. A large diverticulum, stones and tumor in it require diverticulectomy - complete excision of the sac. In both cases, it is necessary to eliminate the cause of urinary stagnation (TUR or HoLEP adenoma, urethrotomy), otherwise the diverticulum recurs.
