經由內視鏡雷射電燒治療巨大膀胱憩室-案例分享

徐易廷¹、黃建榮¹、李淑文¹、薛又仁^1,2、蕭毅君¹、賴昱維^1,2、邱文祥^1,2

¹臺北市立聯合醫院仁愛院區 外科部 泌尿科；²國立陽明交通大學 醫學院 泌尿學科

Endoscopic management of a large bladder diverticulum with laser fulguration- a case report

Yi-Ting Hsu¹, Andy. C. Huang¹, Carol S. Li¹, Thomas Y. Hsueh^1,2, Yi-Chun Hsiao¹, Yu-Wei Lai^1,2, Allen W. Chiu^1,2

¹Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan;

²Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Background: Bladder diverticula commonly manifest in adult men when there is an obstruction at the outlet of the bladder. About 6% of men with benign prostatic hyperplasia tend to have bladder diverticulum. There are various management options available, such as formal diverticulectomy conducted through either an open or laparoscopic approach. Endoscopic alternatives have also been documented, encompassing transurethral resection of the diverticular neck and cauterization of the urothelial mucosa within the diverticulum. This report outlines the utilization of endoscopic cauterization of a large bladder diverticulum with a laser technique.

Case Presentation: A 68-year-old male patient presented to urologic clinic with severe lower urinary tract symptoms. Urinary frequency, nocturia (2-3/night) and weak stream were noted since one year ago. Transrectal ultrasound showed prostate volume of 65 gm. Uroflow study showed low flow rate with Qmax= 12.7m/s and an obstructive flow pattern. Abdominal computed tomography showed a large urinary bladder diverticulum up to 5.7cm on the posterior wall of the bladder. Due to acute urinary retention, foley catheter was placed with urine passage over 1000 cc. The patient was managed with green light laser photovaporization of the prostate and endoscopic fulguration of the bladder diverticulum mucosa with laser. There was near-complete resolution of the bladder diverticulum following endoscopic management, avoiding the need for bladder diverticulectomy. The patient currently emptied his bladder with a postvoiding residual < 50 mL and the absence of urinary tract infection after 3-month follow-up.  

Conclusions: We report a successful treatment of a large bladder diverticulum with endoscopic fulguration by laser technique to near-complete resolution. The minimally invasive technique is a useful option in patients unfit for a more extensive surgical approach.