Dr Jo Schoeman
Urological Surgeon

        

Bladder Diverticulectomy

Product Summary: AMA rates

Open excision of bladder diverticulum. Controversial procedure for the excision of a bladder diverticulum where there is bladder calculus and bladder function is compromised/

Item number: 37020, 105

Why is it done?

  • This procedure is performed when all other treatment options are exhausted with recurrent symptoms.
  • Symptoms include: a weak stream, nightly urination, frequent urination, inability to urinate, sudden cut-off of stream, (LUTS), recurrent bladder infections, recurrent bladder calculi (stones).
  • Medication such as Flomaxtra, Xatral Minipress etc. should always be given as a first resort.
  • Step-up therapy should have been used for prostates larger than 35-50cc with either Duodart, Avodart or Proscar and can be used as a first line in these huge prostates.
  • A TURP may have been performed to dis-obstruct a huge prostate.
  • Neurogenic causes of bladder dysfunction should be excluded by means of a Urodynamic study.
  • Patient informed decision is vital.
  • It provides a quicker solution with more marked side-effects and risks.

How is it done?

  • Patients will receive a general anaesthesia, unless contra-indicated.
  • Prophylactic anti-biotics is given.
  • An indwelling catheter is placed and the bladder is filled with saline.
  • A lower midline incision is made.
  • The retropubic space of Retzuis is entered.
  • The bladder is opened anteriorly in the midline.
  • A Foleys catheter is placed in the diverticulum.
  • The bladder incision is extended to the diverticulum. Diverticulum is excised.
  • Special care is required for divericulae close to the ureters. Placement of ureteric catheters are done to prevent ureteric injury.
  • Bladder is closed in 2 layers over a 3 way irrigation catheter.
  • A drain is left for a couple of days.
  • You may have continuous Antibiotics over the next few days.

What next?

  • You will spend up to 5-7 nights in hospital.
  • You will have a catheter for 14 days.
  • A drain for 2-3 days.
  • You will be discharged as soon as you are drain free, temperature free and have opened your bowels.
  • You may initially suffer from urge symptoms caused by the catheter.
  • There may be some blood in your urine. You can remedy this by drinking plenty of fluids until it clears.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 2 weeksfor a cystogram.
  • Should the cystogram confirm to urine leaks, your catheter will be removed.
  • A review appointment is scheduled 6 weeks later.
  • Don’t hesitate to ask Jo if you have any queries.
  • DON’T SUFFER IN SILENCE, OR YOU WILL SUFFER ALONE!

Side–effects

  • Rarely blood loss requiring blood transfusion.
  • Infection.
  • Prolonged hospital stay.
  • Urine leak requiring prolonged catheterisation.
  • NB! Each person is unique and for this reason symptoms vary!

Bladder Diverticulectomy Bladder Diverticulectomy (415 KB)