Open and Laparoscopic bladder diverticulectomy are established treatment options for symptomatic and complicated bladder diverticulum, with few reports of RABD. Bladder diverticula can be congenital or acquired. Acquired diverticula are often multiple, occur later in life and typically result from bladder outflow obstruction; commonly Benign Prostatic Hyperplasia (1). Surgery is indicated for significant lower urinary tract symptoms, recurrent urinary tract infection (UTI) or complications such as bladder calculi or malignancy (2). We reviewed the surgical and functional outcomes, and quality of life (QoL) of patients treated at a tertiary centre.

All patients who underwent RABD between 2015 and 2019 had data collected prospectively. Data includes patient demographics, operative parameters, functional outcomes and QoL. Surgical outcomes include mean operative time, estimated blood loss, duration of hospital stay, complications and diverticula measurements. Functional outcomes include whether the patient was catheter-dependent, experiencing recurrent UTI and post void residual volumes. QoL was measured using the validated IPSS questionnaire and bother scores, along with simple Likert scale denoting level of benefit with treatment (from -3 to 3).

11 male patients underwent RABD. The average age was 62 years old (43-83). 3 patients had previous bladder outflow obstruction procedures; all Transurethral Resection of the Prostate (TURP). 

The mean operative time was 194 minutes (120–262minutes), estimated blood loss of 111mls (0-250mls) and hospital admission was 2 days (1-5days). 1 patient experienced a grade 3 Clavien-Dindo complication (electively repaired port-site hernia) and 2 had conservatively managed urinary leaks. Mean diverticula volume was 686cm3, detrusor wall thickness was 7mm, diverticular neck diameter was 8mm and mean prostate volume was 43cm3. The average follow up was 19 months (1–43months). 

Functionally; 1 patient was suprapubic catheter dependent pre-operatively and none post-operatively, with 67% reporting recurrent UTIs pre-operatively and 18% post-operatively. 

Mean IPSS improved from 21 + 5 to 7 + 2 and post-void residuals from 429mls to 180mls respectively. No patients subsequently underwent a TURP. Patient self-reported satisfaction is 2.5/3 suggesting good benefit on a simple Likert scale.

In our cohort there was an improvement in functional outcomes as demonstrated by reduced percentage of patients experiencing recurrent UTIs, previously SPC-dependent patient now catheter-free and a reduction in post-void residuals. The IPSS, bother score and Likert scale show an improvement in QoL.

Previous comparison between open vs laparoscopic bladder diverticulectomy show an overall increase in operative time with laparoscopy but reduced estimated blood loss, reduced analgesia requirement and reduced length of hospital stay (3). RABD allows greater dexterity and precision than standard laparoscopy, and our surgical outcomes echo this as a safe approach.

RABD is a safe treatment option for bladder diverticula. This is the third largest reported series to date. Larger study numbers and longer follow up is required to identify prognostic information.

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Porpiglia F, Tarabuzzi R, Cossu M, et al. Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery. Journal of Endourology. 2004;18(1):73–6.