腹腔鏡部分膀胱切除術治療膀胱憩室泌尿上皮腫瘤腫瘤-案例報告及文獻回顧

潘綱凡、李淑文、蕭毅君、賴昱維、黃建榮、薛又仁

台北市聯合醫院仁愛院區 外科部 泌尿外科

Laparoscopic Partial Cystectomy for the Management of Urothelial Carcinoma in Bladder Diverticulum

Gary K. Pan, Shu-Wen Li, Yi-Chun Hsiao, Yu-Wei Lai, Andy C. Huang, Thomas Y. Hsueh

Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan

Purpose: Urothelial carcinoma in bladder diverticulum is a rare disease. The lack of muscularis propria layer, led to pathological upstaging and tumor infiltration, resulting in poor prognosis. We presented a case of 74 year-old man with urothelial carcinoma in bladder diverticulum treated with laparoscopic partial cystectomy.

Case presentation: A 74 year-old man presented to urologic clinic with painless gross hematuria. Right hydronephrosis and left renal stone were spotted via ultrasound. Abdominal computed tomography revealed a diverticulum with focal wall thickening and a stone size of 34 mm at left aspect of urinary bladder. Transurethral resection of bladder tumor and cystolithotripsy was performed simutaneously. Pathology report showed non-invasive high grade papillary urothelial carcinoma. Transperitoneal laparoscopic partial cystectomy was conducted for this patient. Intravesical instillation with mitomycin-C was performed. Intraoperative JJ stent was inserted into left ureter to prevent possible iatrogenic ureter injury. The bladder diverticulum was identified with the assistance of cystoscopic guidance and respected under direct vision. A 2-layer water tight closure with 4-0 and 2-0 chromic catgut was performed. Total operative time was 145 mins and intraoperative blood loss was 100 ml. Pathological report showed high-grade infiltrating urothelial carcinoma, pT3N0M0. Convalescence was uneventful and adjuvant radiation therapy was arranged for this patient. There was no tumor recurrence in the 9-month followup.

Conclusions: Laparoscopic partial cystectomy might be a feasible surgical treatment for urothelial carcinoma of bladder diverticulum in selected patients.