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Minimally invasive surgical approach to treat posterior urethral diverticulum.

Alsowayan O, Almodhen F, Alshammari A - Urol Ann (2015 Apr-Jun)

Bottom Line: It may occur at any point along the urethra in both male and females.Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior.Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Pediatric Urology, King Saud bin Abdul Aziz University for Health Sciences, King Abdul Aziz Medical City, Riyadh, KSA.

ABSTRACT
Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum.

No MeSH data available.


Related in: MedlinePlus

Cystoscopy showing stricture area post-dilatation
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Figure 4: Cystoscopy showing stricture area post-dilatation

Mentions: A 2-year-old boy, born at 29 weeks of gestation, found to have grade I left hydronephrosis, retrovesical cyst and active urinary tract infection (UTI) in the neonatal period. Voiding cystourethrogram (VCUG) showed smooth bladder wall, absence of vesico-ureteric reflux and PUD with insignificant post-void residual [Figure 1]. He was initially managed conservatively. Because of recurrent UTIs and retention episodes, endoscopic marsupialization of the diverticulum using a resectoscope was carried out, which failed to improve the patient's condition. Laparoscopic excision was planned. The patient was placed in dorsal lithotomy position initially. Cystoscopy showed huge PUD with a narrow neck opening proximal and lateral to verumontanum on the right side. 8F Foley's catheter was placed in the diverticulum over a guide wire after bladder evacuation. He was then shifted to supine position. 10 mm port was placed supraumbilically using open technique. After Insufflating peritoneal cavity with CO2-15 mm Hg, 2 other 5 mm ports were placed lateral to the rectus muscle around 1 cm below camera port at mid clavicular line A plane between the bladder and rectum was developed. Distending the diverticulum with saline through the fore placed catheter helped in its identification [Figure 2]. Stay suture was placed through the diverticulum and brought out through the abdominal wall as hitching suture to facilitate its dissection. After completely mobilizing the diverticulum it was opened and its wall was completely excised. Urethral edges were approximated using 5/0 vicryl sutures. Estimated blood loss (EBL) was around 20 cc. The patient was shifted to the floor on IV acetaminophen and cefuroxime. He was discharged home the 2nd day on oral acetaminophen and trimethoprim/sulfamethoxazole prophylaxis. Stent was left in place for 3 weeks. Follow-up VCUG 3 months later showed an area of suspicious stricture, which was confirmed by cystoscopy [Figure 3]. It was thin, passable and managed by simple dilatation [Figure 4]. The patient has been having good stream with no significant residual urine since then.


Minimally invasive surgical approach to treat posterior urethral diverticulum.

Alsowayan O, Almodhen F, Alshammari A - Urol Ann (2015 Apr-Jun)

Cystoscopy showing stricture area post-dilatation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374276&req=5

Figure 4: Cystoscopy showing stricture area post-dilatation
Mentions: A 2-year-old boy, born at 29 weeks of gestation, found to have grade I left hydronephrosis, retrovesical cyst and active urinary tract infection (UTI) in the neonatal period. Voiding cystourethrogram (VCUG) showed smooth bladder wall, absence of vesico-ureteric reflux and PUD with insignificant post-void residual [Figure 1]. He was initially managed conservatively. Because of recurrent UTIs and retention episodes, endoscopic marsupialization of the diverticulum using a resectoscope was carried out, which failed to improve the patient's condition. Laparoscopic excision was planned. The patient was placed in dorsal lithotomy position initially. Cystoscopy showed huge PUD with a narrow neck opening proximal and lateral to verumontanum on the right side. 8F Foley's catheter was placed in the diverticulum over a guide wire after bladder evacuation. He was then shifted to supine position. 10 mm port was placed supraumbilically using open technique. After Insufflating peritoneal cavity with CO2-15 mm Hg, 2 other 5 mm ports were placed lateral to the rectus muscle around 1 cm below camera port at mid clavicular line A plane between the bladder and rectum was developed. Distending the diverticulum with saline through the fore placed catheter helped in its identification [Figure 2]. Stay suture was placed through the diverticulum and brought out through the abdominal wall as hitching suture to facilitate its dissection. After completely mobilizing the diverticulum it was opened and its wall was completely excised. Urethral edges were approximated using 5/0 vicryl sutures. Estimated blood loss (EBL) was around 20 cc. The patient was shifted to the floor on IV acetaminophen and cefuroxime. He was discharged home the 2nd day on oral acetaminophen and trimethoprim/sulfamethoxazole prophylaxis. Stent was left in place for 3 weeks. Follow-up VCUG 3 months later showed an area of suspicious stricture, which was confirmed by cystoscopy [Figure 3]. It was thin, passable and managed by simple dilatation [Figure 4]. The patient has been having good stream with no significant residual urine since then.

Bottom Line: It may occur at any point along the urethra in both male and females.Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior.Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Division of Pediatric Urology, King Saud bin Abdul Aziz University for Health Sciences, King Abdul Aziz Medical City, Riyadh, KSA.

ABSTRACT
Urethral diverticulum is a localized saccular or fusiform out-pouching of the urethra. It may occur at any point along the urethra in both male and females. Male urethral diverticulum is rare, and could be either congenital or acquired, anterior or posterior. The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach. Here we discuss our minimally invasive surgical approach (MIS) in managing posterior urethral diverticulum.

No MeSH data available.


Related in: MedlinePlus