Abstract
Introduction The objective of this study was to report on the use of vesicoscopy in the treatment
of symptomatic congenital bladder diverticula (CBD) in children.
Material and Methods In this study, 16 males, aged 4 to 12 years (median age, 6.25 years), were treated
for symptomatic CBD; 3 patients presented double diverticulum and 13 presented single
diverticulum. The presenting symptoms were recurrent urinary tract infection, hematuria,
lower abdominal pain, and voiding dysfunctions as urgency, frequency alone, or in
association. A first midline 5-mm trocar was introduced for a 0-degree telescope at
the dome of the bladder, and two left and right 3- or 5-mm trocars were inserted through
the anterolateral wall. The bladder was then insufflated with carbon dioxide to 10
to 12 mm Hg pressure. The diverticula were inverted into the bladder and the mucosa
around the neck was circumcised by using scissors and hook. The defect was sutured
and the bladder was drained. Vesicoureteral reflux (VUR) of third grade or higher
was treated endoscopically.
Results Mean operative time was 90 minutes for procedures. At 6-month follow-up, ultrasound
and voiding cystourethrogram (VCUG) showed the disappearance of the diverticulum in
15 out of the 16 patients. The patient, with huge double diverticulum and fourth grade
right VUR, presented recurrence of a small left diverticulum. Patients with voiding
disorders presented a gradual improvement of their urgency. VUR disappeared at VCUG
in all patients.
Conclusion Vesicoscopic diverticulectomy resulted a safe and effective procedure and can be
considered a valid alternative to the open or laparoscopic procedures. In our opinion,
routine use of vesicoscopy could become the gold standard for the treatment of CBD
in children.
Keywords
laparoscopy - diverticulum - bladder - children
