Clinical analyses of laparoscopic congenital bladder diverticulectomy with target-guided method

Objective To summarize the experiences of mini-invasive surgery for congenital bladder diverticulum (CBD) by target-guided method of urethral catheter and cystoscope light source in children. Methods Retrospective reviews were conducted for age, gender, chief complaint, diverticula size, clinical and urodynamic findings and surgical approaches of 12 CBD patients from January 2006 to January 2016. Results All children were successfully operated without any conversion into laparotomy. The average operative duration was 135 (120-160) mins and the average volume of blood loss 40 (20-75) ml. Two cases of bladder calculus were detected. And another two cases of mild vesicoureteral reflux did not undergo ureteral bladder replantation. There was no onset of overt postoperative complications. Two cases were followed up for 3 months and the remainder for 1 year. Re-examinations included urinary culture and urinary ultrasound after 3 months; voiding cystourethrography (VCUG) and urodynamic examination after 6 months; urinary ultrasound after 1 year. The follow-up outcomes were excellent. Conclusions Congenital bladder diverticulum should be differentiated from lower urinary tract obstruction due to secondary diverticulum. As a gold diagnostic standard, VCUG may be combined with cystoscopy and urodynamic examination for a definite diagnosis. Surgical intervention criteria for congenital bladder diverticula have not been made. Recommended surgical indications include a diverticulum with a diameter of >3 cm or a diverticulum associated with such clinical symptoms as urinary tract infection, dysuria and urinary retention The above targeted method may aid the identification of diverticulum wall of bladder, avoid the damages of ureter, vas deferens, seminal vesicles and pelvic plexus and reduce the occurrences of operative complications during complete removal of diverticulum. Key words: Surgical procedures, laparoscopic; Bladder; Diverticulum