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Surgery to Improve Reservoir Function
Published in Jacques Corcos, Gilles Karsenty, Thomas Kessler, David Ginsberg, Essentials of the Adult Neurogenic Bladder, 2020
Procedure: Originally described by Cartwright and Snow in 19899 (Figure 31.2), it primarily consists of carefully removing the muscle from the dome of the bladder, and thus creating a very large bladder diverticulum. Essentially, as an open procedure, an area around the dome is carefully circumscribed from posterior to anterior initially in the midline and then circumferentially, about three-quarters of the distance to the urothelium, with electrocautery and the rest of the way carefully separated using a hemostat; the bladder is then filled through a Foley catheter; and then Allis clamps are applied to one edge and the muscle of the dome of the bladder is carefully removed working laterally. This creates a very large diverticulum. Care is taken to not make holes in the urothelium. Bilateral psoas hitches are then performed with absorbable suture. It is generally considered that the extra capacity has to be maintained early after the operation, but how much volume or pressure has not been determined. Postoperatively, a cystogram should be performed to check for leakage, prior to restarting the intermittent catheterization, usually around 5–6 days, and also a drain should be placed near the operative site to detect and control any urinary leaks and removed after confirmation of no leaks. The procedure seems to work well where the patients are younger, and also when the bladder capacity is about 75%–80% of expected capacity for age.10
Answers
Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Bladder diverticulum is acquired because of a chronic increase in intravesical pressure causing bladder mucosa to push through the muscle layer. They can become chronically colonised with such bacteria as Pseudomonas or ESBL E. coli and cause chronic infection. (2)
Cytology of Bladder Cancer
Published in George T. Bryan, Samuel M. Cohen, The Pathology of Bladder Cancer, 2017
Squamous cell carcinoma, apart from the squamous differentiation occurring in nonpapillary and high-grade transitional cell carcinoma, is commonly associated with schistosomiasis in areas of the world harboring Schistosoma haematobium. In the absence of this association, squamous cell carcinoma is rare; if it occurs, it may be in conjunction with chronic and recurrent inflammatory conditions, such as cord bladder, diverticulum, and stone. Such conditions are often the sites of squamous metaplasia with varying degrees of atypia ranging to carcinoma in situ. The squamous carcinomas are usually graded according to Broder’s system.
Urinary bladder rupture years after excision of urachal remnant
Published in Baylor University Medical Center Proceedings, 2020
Zoe Blumenthal, Kim H. Thai, Faris Hashim, Jeffrey Waxman, Marawan M. El Tayeb
Spontaneous urinary bladder rupture is a rare yet life-threatening clinical phenomenon. In the absence of trauma, spontaneous bladder rupture has been associated with pelvic malignancy, vaginal delivery, bladder infections, radiation therapy, congenital genitourinary malformations, bladder augmentation surgery, neurogenic bladder, urinary retention, and benzodiazepine overdose.1–4 In the pediatric population, the leading causes of rupture in reported cases are neurogenic bladders, bladder diverticulum, bladder outlet obstruction, and history of bladder augmentation surgery.3 Patients with a ruptured bladder typically present with abdominal pain, distension, dysuria, and decreased urinary output.5 Nontraumatic rupture has mortality rates approaching 50%.1
Efficacy analysis of a novel thermochemotherapy scheme with pirarubicin for intermediate- and high-risk nonmuscle-invasive bladder cancer: a single-institution nonrandomized concurrent controlled trial
Published in International Journal of Hyperthermia, 2019
Jun Zhou, Linlin Li, Xing Li, Qian Yu, Shaowei Cui, Kunpeng Shu, Jianjun Liu, Jie Liu, Degang Ding, Tao Du
From June 2012 to December 2016, 300 cases of pathologically confirmed bladder cancer were enrolled in the study; all cases underwent intravesical instillation therapy with THP after TURBT in Henan Provincial People's Hospital (Zhengzhou, China). Inclusion criteria included age >18 years, Eastern Cooperative Oncology Group performance status <2, life expectancy >24 months and intermediate- and/or high-risk NMIBC as defined by the European Association of Urology NMIBC guidelines [22]. Exclusion criteria included perioperative death, intention to conceive, pregnant/lactating women, THP allergy, the use of other intravesical treatment agents during treatment, end-stage cachexia, severe bleeding disorder, bladder diverticulum >1 cm, residual urine >100 ml, bladder volume <150 ml, active urinary tract infection, urinary incontinence, urethral stricture impeding 20 F catheterization, nonurothelial histology, coexisting upper urinary tract (renal pelvis, ureter) tumors, previous history of upper urinary tract tumors, clinical stage T2, partial cystectomy, previous pelvic radiotherapy/systemic chemotherapy and previous intravesical chemotherapy. The TNM classification for bladder cancer was used to define the stage of NMIBC [23] while histological grade was defined by the World Health Organization 1973 grading system.
Robotic bladder diverticulectomy: step-by-step extravesical posterior approach – technique and outcomes
Published in Scandinavian Journal of Urology, 2018
Giovanni Cacciamani, Nicolò De Luyk, Vincenzo De Marco, Marco Sebben, Leonardo Bizzotto, Davide De Marchi, Maria Angela Cerruto, Salvatore Siracusano, Antonio Benito Porcaro, Walter Artibani
A bladder diverticulum (BD) is an outpouching of the bladder through a defect in the bladder wall. A BD can be classified as congenital or acquired. The latter are more common in older patients with benign prostatic obstruction or urethral stricture. Clinically significant BD in men are uncommon. BD contain only scattered muscle fibres and this results in high residual urine volume that causes refractory lower urinary tract symptoms (LUTS), urinary infection, bladder calculi, ureteral ‘ab extrinseco’ obstruction or cancer in diverticulum [1]. BD may undergo neoplastic changes in 1–10% of cases [2]. The increased risk of bladder cancer in diverticula has been attributed to urinary stasis and to chronic inflammation [3]. A surgical approach is needed to relieve symptoms. Several surgical options for the correction of BD have been described, including open (with extravesical or intravesical approaches, or both), endoscopic (fulguration, BD neck resection) and laparoscopic (extraperitoneal, intraperitoneal or transvesical approaches) procedures [4]. Within the past few years, robotic surgery has been suggested as another possible approach. This article reports the authors’ preliminary experience of robot-assisted bladder diverticulectomy (RBD) using the da Vinci SI® Surgical System, describing surgical technique, perioperative management and outcomes.