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재발성 방광염을 초래하는 큰 방광게실을 동반한 소아에서 경방광경 방광게실제거술 |
| 성균관대학교 의과대학 비뇨기과학교실, 한림대학교 의과대학 비뇨기과학교실 |
| 최중원¹, 고광진², 한덕현¹, 백민기¹ |
A 3-year-old boy has suffered from recurrent afebrile urinary tract infections. After his third urinary tract infection, he underwent ultrasound which revealed that he has a huge bladder diverticulum. He has no abnormal storage symptoms such as frequency, urgency, or urge incontinence. He has no abnormal voiding symptoms suggesting bladder outlet obstruction. On video-urodynamic study, the bladder diverticulum seems to be located at posterior bladder wall without vesicoureteral reflux.
We used pneumovesicoscopic approach as a minimally invasive surgical modality for the removal of bladder diverticulum. Under a direct cystoscopic vision, a 3 mm midline trocar for a 30-degree telescope is inserted directly into the bladder through the abdominal wall. Via the trocar, the bladder is insufflated by CO2 gas to 10 - 12 mmHg pressure. Two lateral 3 mm trocars are then inserted thorough the anterolateral wall of the bladder. The bladder wall can be fixated to the abdominal wall at the trocar sites using non-absorbable suture to help prevent dislodgement of the trocars. The diverticulum is inverted into the bladder, and the mucosa around the neck of the diverticulum is circumscribed with the use of laparoscopic scissors and a monopolar hook. To help prevent injury to the associated ureter, a ureteral catheter can be inserted prior to dissection. After complete dissection of the bladder diverticulum is performed, the diverticulum can be excised. The remaining bladder wall defect is closed in an interrupted fashion with absorptive 4-0 and 6-0 Vicryl. The bladder is then drained with a urethral 6 Fr. Foley catheter. There was no peri- and post-operative complication. The patient discharged on the postoperative 1 day after Foley catheter removal.
Pneumovesicoscopic diverticulectomy is associated with short hospital stays, rapid recovery, and good cosmetic results. This approach allows for easy identification of the diverticula and facilitates the dissection because of the direct laparoscopic view into the bladder.
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keywords : bladder diverticulum, laparoscopy, children |
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