Presented by: Michael Frumer MD
Rabin Medical Center

Introduction

Bladder diverticulum can be secondary to prostatic enlargement with bladder outlet obstruction and be a source of high postvoid residuals prompting surgical intervention. This study aims to describe the early and intermediate-term outcomes of patients with bladder diverticulum undergoing holmium laser enucleation of the prostate (HoLEP).

Materials

Preoperative, perioperative, and postoperative patients’ variables were assessed retrospectively. The study group included patients with at least one diverticulum of 2 cm or more in diameter. Only those operated on until the end of 2021 were included to allow for a relatively long follow-up.

Results

,

Among the 596 patients who underwent HoLEP at our institution until the end of 2021, 26 patients (4%) had diverticula measuring 2 cm or larger. The median prostate size was 92 cc (IQR 76, 121), and the median diverticulum size (largest if multiple) was 3.7 cm (IQR 2.5, 5). Preoperatively, 11 patients (42%) required an indwelling urinary catheter. In the rest, the median preoperative post-void residual was 180 ml (IQR 68, 338). Perioperatively, no patient had a fever and one patient (4%), with prostate size of 210 g and long-term use of blood thinners, required blood transfusion. Emergency department visits within 30 days included three hematuria (12%), one dysuria with negative urine culture  (4%), and one transient urinary retention  (4%). In a median follow-up of 34 months (IQR 25, 53), all patients were voiding with no residual urine, four patients (16%) had urinary tract infection events, two patients (8%) required more than one pad per day, and none required diverticulectomy.

Conclusion

HoLEP is an effective treatment method for outlet obstruction in patients with bladder diverticula. Following the alleviation of the outlet obstruction, most patients do not require additional treatment and can avoid more invasive surgical interventions.

Funding

none

Co-Authors

Iyad Khamaisi, MD
Rabin Medical Center

Tzach Aviv, MD
Rabin Medical Center

Sagi Arieh Shpitzer, MD
Rabin Medical Center

Tomer Weizman, MD
Rabin Medical Center

Hen Hendel, MD
Rabin Medical Center

Gherman Creiderman, MD
Rabin Medical Center

Ron Gilad, MD
Rabin Medical Center

Krenawi Muhammad, MD
Rabin Medical Center

Shayel Bercovich, MD
Rabin Medical Center

Nadav Dekel, MD
Rabin Medical Center

Hadar Tamir, MD
Rabin Medical Center

Tal Wax, MD
Rabin Medical Center

Tomer Hasdai, MD
Rabin Medical Center

Yossi Ventura, MD
Rabin Medical Center

Niv Segal, MD
Rabin Medical Center

Liran Zieber, MD
Rabin Medical Center

Dmitry Enikeev, MD, PhD
Rabin Medical Center

Abd Elhalim Darawsha, MD
Rabin Medical Center

Yaron Ehrlich, MD
Rabin Medical Center