Endoscopic surgery of bladder diverticula

The most frequent method utilized in the treatment of bladder diverticula is by open surgery using the extravesical, transvesical or combined approach. The endoscopic techniques consisting of electrocoagulation of the diverticular mucosa alone (Orandi) or opening the diverticular neck by electroresection (Post-Vitale) constitute a therapeutic alternative not widely used to date. We have attempted to combine both techniques and, since 1985, we have treated 21 patients with bladder diverticula via the transurethral approach using the following technique: 1. The diverticular neck is opened wide by incision or electroresection. 2. Complete electrocoagulation of the diverticular mucosa. 3. Resolution of cervico-urethral obstruction by cervico-prostatic incision or electroresection of the prostate. We have achieved good results and no complications have been observed. Reduction of the diverticulum was not achieved in only one case. In our view, failure was due to the fact that treatment of the diverticulum had not been combined with prostate resection which the patient refused. The technique is described and the indications and possible complications are discussed. The results achieved by the authors indicate that this technique should be used more widely.