V-264 Presentación: Vídeo

Compressive Hydronephrosis by Bladder Diverticulum - Laparoscopic Diverticulum
Vinagre, Nuno; Mesquita, Sofia; Monteiro, Miguel; Oliveira, Beatriz; Magalhães, Martinha; Oliveira, Manuel
Unidade Local de Saúde de Santo António

Bladder diverticulum, a condition resulting from a defect in detrusor muscle fibers, often remains asymptomatic and is typically discovered incidentally during investigations unrelated to urinary tract infections. Large diverticula may lead to slow or incomplete emptying after voiding, causing symptoms due to urine stagnation or its mass effect in the lower abdomen.

This video presents a laparoscopic diverticulectomy case involving a 49-year-old male with voiding symptoms, back pain, and bilateral hydronephrosis due to a large bladder diverticulum. The patient underwent a kidney and bladder ultrasound, revealing a 28-gram prostate, reduced parenchymal thickness, and a CT scan indicating bilateral hydronephrosis, complete ectasia of the right ureter, and a compressive diverticulum, accompanied by increased serum creatinine. To address symptoms and improve renal function, the decision was made to undergo laparoscopic diverticulectomy. In the operating room, a rigid cystoscopy identified multiple diverticula, with two larger ones on the right lateral wall. The patient was positioned at 30º in Trendelenburg, and four trocars were placed in the anterior abdominal wall. The right ureter was dissected, leading to successful closure of the diverticulum orifice on the right vesical wall. The left ureter's identification and dissection were challenging due to a voluminous diverticulum on the left lateral wall but with a neck on the posterior wall. Despite the complexity, closure of the left ureter's orifice was achieved without complications. Operative pieces were extracted using a collection bag, and a drain was placed.

Postoperatively, the patient developed a small fever on day 3, necessitating antibiotics for a urinary tract infection. Discharged on day 8 with stable hemoglobin, improved renal function, and resolved hydronephrosis, the patient later experienced acute urinary retention, necessitating a urinary catheter. Subsequently, self-catheterization was initiated, with an urodynamic study pending.

In summary, the laparoscopic diverticulectomy procedure effectively addressed the patient's voiding symptoms and back pain, leading to improved renal function.