Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach

Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective. Ausführliche Beschreibung

Gespeichert in:

Autor*in:	Gianluca Giannarini [verfasserIn] Marta Rossanese [verfasserIn] Luciano Macchione [verfasserIn] Giuseppe Mucciardi [verfasserIn] Alessandro Crestani [verfasserIn] Vincenzo Ficarra [verfasserIn]

Format:	E-Artikel
Sprache:	Englisch

Erschienen:	2022

Schlagwörter:	Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction

Übergeordnetes Werk:	In: European Urology Open Science - Elsevier, 2020, 44(2022), Seite 162-168
Übergeordnetes Werk:	volume:44 ; year:2022 ; pages:162-168

Links:	Link aufrufen Link aufrufen Link aufrufen Journal toc

DOI / URN:	10.1016/j.euros.2022.08.016

Katalog-ID:	DOAJ031720196

Internformat


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520			\|a Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective.
650		4	\|a Bladder
650		4	\|a Diverticulum
650		4	\|a Lower urinary tract symptoms
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650		4	\|a Bladder outlet obstruction
653		0	\|a Diseases of the genitourinary system. Urology
653		0	\|a Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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700	0		\|a Luciano Macchione \|e verfasserin \|4 aut
700	0		\|a Giuseppe Mucciardi \|e verfasserin \|4 aut
700	0		\|a Alessandro Crestani \|e verfasserin \|4 aut
700	0		\|a Vincenzo Ficarra \|e verfasserin \|4 aut
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allfields	10.1016/j.euros.2022.08.016 doi (DE-627)DOAJ031720196 (DE-599)DOAJ65e3886919bd428d9ade484e8b95feab DE-627 ger DE-627 rakwb eng RC870-923 RC254-282 Gianluca Giannarini verfasserin aut Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective. Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction Diseases of the genitourinary system. Urology Neoplasms. Tumors. Oncology. Including cancer and carcinogens Marta Rossanese verfasserin aut Luciano Macchione verfasserin aut Giuseppe Mucciardi verfasserin aut Alessandro Crestani verfasserin aut Vincenzo Ficarra verfasserin aut In European Urology Open Science Elsevier, 2020 44(2022), Seite 162-168 (DE-627)1734491795 26661683 nnns volume:44 year:2022 pages:162-168 https://doi.org/10.1016/j.euros.2022.08.016 kostenfrei https://doaj.org/article/65e3886919bd428d9ade484e8b95feab kostenfrei http://www.sciencedirect.com/science/article/pii/S2666168322008862 kostenfrei https://doaj.org/toc/2666-1683 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 44 2022 162-168
spelling	10.1016/j.euros.2022.08.016 doi (DE-627)DOAJ031720196 (DE-599)DOAJ65e3886919bd428d9ade484e8b95feab DE-627 ger DE-627 rakwb eng RC870-923 RC254-282 Gianluca Giannarini verfasserin aut Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective. Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction Diseases of the genitourinary system. Urology Neoplasms. Tumors. Oncology. Including cancer and carcinogens Marta Rossanese verfasserin aut Luciano Macchione verfasserin aut Giuseppe Mucciardi verfasserin aut Alessandro Crestani verfasserin aut Vincenzo Ficarra verfasserin aut In European Urology Open Science Elsevier, 2020 44(2022), Seite 162-168 (DE-627)1734491795 26661683 nnns volume:44 year:2022 pages:162-168 https://doi.org/10.1016/j.euros.2022.08.016 kostenfrei https://doaj.org/article/65e3886919bd428d9ade484e8b95feab kostenfrei http://www.sciencedirect.com/science/article/pii/S2666168322008862 kostenfrei https://doaj.org/toc/2666-1683 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 44 2022 162-168
allfields_unstemmed	10.1016/j.euros.2022.08.016 doi (DE-627)DOAJ031720196 (DE-599)DOAJ65e3886919bd428d9ade484e8b95feab DE-627 ger DE-627 rakwb eng RC870-923 RC254-282 Gianluca Giannarini verfasserin aut Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective. Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction Diseases of the genitourinary system. Urology Neoplasms. Tumors. Oncology. Including cancer and carcinogens Marta Rossanese verfasserin aut Luciano Macchione verfasserin aut Giuseppe Mucciardi verfasserin aut Alessandro Crestani verfasserin aut Vincenzo Ficarra verfasserin aut In European Urology Open Science Elsevier, 2020 44(2022), Seite 162-168 (DE-627)1734491795 26661683 nnns volume:44 year:2022 pages:162-168 https://doi.org/10.1016/j.euros.2022.08.016 kostenfrei https://doaj.org/article/65e3886919bd428d9ade484e8b95feab kostenfrei http://www.sciencedirect.com/science/article/pii/S2666168322008862 kostenfrei https://doaj.org/toc/2666-1683 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 44 2022 162-168
allfieldsGer	10.1016/j.euros.2022.08.016 doi (DE-627)DOAJ031720196 (DE-599)DOAJ65e3886919bd428d9ade484e8b95feab DE-627 ger DE-627 rakwb eng RC870-923 RC254-282 Gianluca Giannarini verfasserin aut Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective. Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction Diseases of the genitourinary system. Urology Neoplasms. Tumors. Oncology. Including cancer and carcinogens Marta Rossanese verfasserin aut Luciano Macchione verfasserin aut Giuseppe Mucciardi verfasserin aut Alessandro Crestani verfasserin aut Vincenzo Ficarra verfasserin aut In European Urology Open Science Elsevier, 2020 44(2022), Seite 162-168 (DE-627)1734491795 26661683 nnns volume:44 year:2022 pages:162-168 https://doi.org/10.1016/j.euros.2022.08.016 kostenfrei https://doaj.org/article/65e3886919bd428d9ade484e8b95feab kostenfrei http://www.sciencedirect.com/science/article/pii/S2666168322008862 kostenfrei https://doaj.org/toc/2666-1683 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 44 2022 162-168
allfieldsSound	10.1016/j.euros.2022.08.016 doi (DE-627)DOAJ031720196 (DE-599)DOAJ65e3886919bd428d9ade484e8b95feab DE-627 ger DE-627 rakwb eng RC870-923 RC254-282 Gianluca Giannarini verfasserin aut Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach 2022 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective. Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction Diseases of the genitourinary system. Urology Neoplasms. Tumors. Oncology. Including cancer and carcinogens Marta Rossanese verfasserin aut Luciano Macchione verfasserin aut Giuseppe Mucciardi verfasserin aut Alessandro Crestani verfasserin aut Vincenzo Ficarra verfasserin aut In European Urology Open Science Elsevier, 2020 44(2022), Seite 162-168 (DE-627)1734491795 26661683 nnns volume:44 year:2022 pages:162-168 https://doi.org/10.1016/j.euros.2022.08.016 kostenfrei https://doaj.org/article/65e3886919bd428d9ade484e8b95feab kostenfrei http://www.sciencedirect.com/science/article/pii/S2666168322008862 kostenfrei https://doaj.org/toc/2666-1683 Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_224 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2001 GBV_ILN_2003 GBV_ILN_2005 GBV_ILN_2006 GBV_ILN_2007 GBV_ILN_2008 GBV_ILN_2009 GBV_ILN_2010 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2015 GBV_ILN_2020 GBV_ILN_2021 GBV_ILN_2025 GBV_ILN_2026 GBV_ILN_2027 GBV_ILN_2034 GBV_ILN_2038 GBV_ILN_2044 GBV_ILN_2048 GBV_ILN_2049 GBV_ILN_2050 GBV_ILN_2055 GBV_ILN_2056 GBV_ILN_2059 GBV_ILN_2061 GBV_ILN_2064 GBV_ILN_2088 GBV_ILN_2106 GBV_ILN_2110 GBV_ILN_2112 GBV_ILN_2122 GBV_ILN_2129 GBV_ILN_2143 GBV_ILN_2152 GBV_ILN_2153 GBV_ILN_2190 GBV_ILN_2232 GBV_ILN_2336 GBV_ILN_2470 GBV_ILN_2507 GBV_ILN_4012 GBV_ILN_4035 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4242 GBV_ILN_4249 GBV_ILN_4251 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4326 GBV_ILN_4333 GBV_ILN_4334 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4393 GBV_ILN_4700 AR 44 2022 162-168
language	English
source	In European Urology Open Science 44(2022), Seite 162-168 volume:44 year:2022 pages:162-168
sourceStr	In European Urology Open Science 44(2022), Seite 162-168 volume:44 year:2022 pages:162-168
format_phy_str_mv	Article
institution	findex.gbv.de
topic_facet	Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction Diseases of the genitourinary system. Urology Neoplasms. Tumors. Oncology. Including cancer and carcinogens
isfreeaccess_bool	true
container_title	European Urology Open Science
authorswithroles_txt_mv	Gianluca Giannarini @@aut@@ Marta Rossanese @@aut@@ Luciano Macchione @@aut@@ Giuseppe Mucciardi @@aut@@ Alessandro Crestani @@aut@@ Vincenzo Ficarra @@aut@@
publishDateDaySort_date	2022-01-01T00:00:00Z
hierarchy_top_id	1734491795
id	DOAJ031720196
language_de	englisch
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Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. 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callnumber-first	R - Medicine
author	Gianluca Giannarini
spellingShingle	Gianluca Giannarini misc RC870-923 misc RC254-282 misc Bladder misc Diverticulum misc Lower urinary tract symptoms misc Benign prostate enlargement misc Benign prostate hyperplasia misc Bladder outlet obstruction misc Diseases of the genitourinary system. Urology misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach
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topic_title	RC870-923 RC254-282 Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach Bladder Diverticulum Lower urinary tract symptoms Benign prostate enlargement Benign prostate hyperplasia Bladder outlet obstruction
topic	misc RC870-923 misc RC254-282 misc Bladder misc Diverticulum misc Lower urinary tract symptoms misc Benign prostate enlargement misc Benign prostate hyperplasia misc Bladder outlet obstruction misc Diseases of the genitourinary system. Urology misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_unstemmed	misc RC870-923 misc RC254-282 misc Bladder misc Diverticulum misc Lower urinary tract symptoms misc Benign prostate enlargement misc Benign prostate hyperplasia misc Bladder outlet obstruction misc Diseases of the genitourinary system. Urology misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
topic_browse	misc RC870-923 misc RC254-282 misc Bladder misc Diverticulum misc Lower urinary tract symptoms misc Benign prostate enlargement misc Benign prostate hyperplasia misc Bladder outlet obstruction misc Diseases of the genitourinary system. Urology misc Neoplasms. Tumors. Oncology. Including cancer and carcinogens
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title	Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach
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title_full	Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach
author_sort	Gianluca Giannarini
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author_browse	Gianluca Giannarini Marta Rossanese Luciano Macchione Giuseppe Mucciardi Alessandro Crestani Vincenzo Ficarra
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title_sort	robot-assisted bladder diverticulectomy using a transperitoneal extravesical approach
callnumber	RC870-923
title_auth	Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach
abstract	Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective.
abstractGer	Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective.
abstract_unstemmed	Background: Acquired bladder diverticula (BD) are a possible complication of bladder outlet obstruction (BOO) due to benign prostate enlargement (BPE). Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective.
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title_short	Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach
url	https://doi.org/10.1016/j.euros.2022.08.016 https://doaj.org/article/65e3886919bd428d9ade484e8b95feab http://www.sciencedirect.com/science/article/pii/S2666168322008862 https://doaj.org/toc/2666-1683
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Robot-assisted bladder diverticulectomy (RABD) has been proposed as an alternative to open removal; however, only a few small series have been published. Objective: To describe our surgical technique for RABD and to assess perioperative results and functional outcomes at 6-mo follow-up. Design, setting, and participants: A prospective single-centre, single-surgeon cohort of 16 consecutive men with posterior or posterolateral BD due to BOO/BPE undergoing RABD between May 2017 and December 2021 was analysed. Surgical procedure: RABD was performed with a four-arm robotic system via a transperitoneal approach. BD were identified intraoperatively via bladder distension with saline solution through an indwelling catheter with or without concomitant illumination using flexible cystoscopy and fluorescence imaging. Extravesical BD dissection and removal were performed. Outcome measurements and statistical analysis: Operating room time, estimated blood loss, intraoperative and postoperative complications, indwelling catheter time, and timing of associated procedures for BOO/BPE were assessed. The International Prostate Symptom Score (IPSS) and postvoid residual volume (PVR) were compared between baseline and 6 mo after surgery. Results and limitations: Median age and maximum BD diameter were 68 yr (interquartile range [IQR] 54–74) and 69 mm (IQR 51–82), respectively. The median operative time was 126 min (IQR 92–167) and the median estimated blood loss was 20 ml (IQR 15–40). No intraoperative complications were recorded. The urethral catheter was removed on median postoperative day 5 (IQR 5–7). Two men experienced 90-d postoperative complications (persistent urinary infection requiring prolonged antimicrobial therapy). Bipolar transurethral resection of the prostate was performed 3 wk before RABD in seven men and concomitant to RABD in nine men. Median IPSS significantly decreased from 25 (IQR 21–30) to 5 (IQR 5–6), and median PVR from 195 ml (IQR 140–210 ml) to 30 (IQR 28–40) ml (both p < 0.001) at 6-mo follow-up in comparison to baseline. A limitation is the rather small cohort with no control group. Conclusions: RABD is a safe and effective minimally invasive option for treatment of acquired BD in men with BOO/BPE. Validation of our results in larger series with longer follow-up is warranted. Patient summary: We describe our surgical technique for robot-assisted removal of pouches in the bladder wall (called diverticula) in men with bladder outlet obstruction caused by benign prostate enlargement, and report functional results at 6 months after the operation. This minimally invasive technique was found to be safe and effective.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Bladder</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Diverticulum</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Lower urinary tract symptoms</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Benign prostate enlargement</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Benign prostate hyperplasia</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Bladder outlet obstruction</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Diseases of the genitourinary system. Urology</subfield></datafield><datafield tag="653" ind1=" " ind2="0"><subfield code="a">Neoplasms. Tumors. Oncology. 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Robot-assisted Bladder Diverticulectomy Using a Transperitoneal Extravesical Approach

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