內視鏡經尿道燒灼治療因巨大膀胱憩室引起的尿滯留---病例報告

曾博鴻、陳柏華

彰化基督教醫院 外科部 泌尿科

Endoscopic Transurethral Fulguration for Acute Urine Retention Resulting from a Huge Bladder Diverticulum: A Case Report

Po-Hung Tseng, Pao-Hwa Chen

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction

Bladder diverticula in adult typically occur in the setting of bladder outlet obstruction. The prevalence of bladder diverticula in association with benign prostatic hyperplasia (BPH) is approximately 6%. Most diverticula are asymptomatic and small, they can be incidentally discovered on evaluation for hematuria, bladder outlet obstruction, urine retention or urinary tract infection. Large diverticulum requires diverticulectomy either by open, laparoscopic or transurethral methods.

Case report

This 79-year-old male has past history of benign prostatic hyperplasia with urinary difficulty for several years. He presented acute urinary retention with less urine output drained from Foley’s catheter. Contrast-enhanced computed tomography demonstrated a huge lobulated cystic mass at lower abdomen and pelvic cavity. There were connections between the “cystic mass” and cystoscopy found urine retention at a huge bladder diverticulum at posterior wall near trigone with narrow neck connected to urinary bladder. Thus, the patient underwent transurethral fulguration of bladder diverticulum and incise the diverticular neck with resectoscope. 20Fr. Three-way Foley’s catheter was inserted into bladder with continuous bladder irrigation and drainage. There were no complications included hematuria or urine retention post-operatively.

Conclusion

Considered patients who may be unfit for open or laparoscopic surgery for large or symptomatic bladder diverticulum, such as older patients with comorbidities, patients with previous abdominal surgery or radiation and patients on anticoagulation therapy. Endoscopic transurethral fulguration offers an alternative choice and favorable outcome. It may be insufficient for total diverticulectomy, but it is clinically effective.