Endoscopic option
A narrow neck is the cause of stagnation of urine in the diverticulum. Through the urethra, using a resectoscope or holmium laser, the neck is dissected at 2–4 points or resected around the circumference, the mucous membrane of the diverticulum is examined and, if necessary, coagulated; if there is a small stone inside, it is crushed and removed. The same operation often includes TUR of adenomas to eliminate the cause. The catheter is installed for 2–3 days. The method is not suitable for diverticulums larger than 5–6 cm, a tumor in it and involvement of the ureteral orifice - then diverticulectomy is indicated.
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.
