Bladder Diverticulectomy

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!

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Bladder Diverticulectomy