extravesical diverticulectomy

The bladder diverticulum is the outwardly protruding bladder wall that communicates with the bladder cavity, and its causes are divided into congenital and acquired. Congenital bladder diverticulum is caused by defects in bladder muscle development during embryonic period. There is no lower urinary tract obstruction. It occurs in children under 10 years old. The diverticulum is usually larger and often single. Acquired bladder diverticulum due to lower urinary tract obstruction, mostly occurred in adults aged 40 to 60 years, often multiple, in addition to the bladder outside the bladder, there are changes in trabeculae, small rooms and depression. Bladder diverticulum occurs mostly in the posterior and posterior wall of the bladder triangle. It can cause many complications, such as infection, stone formation, tumors, bleeding, obstruction of the ureter, and even perforation. Uncomplicated bladder diverticulum often has no obvious clinical symptoms. Difficulties in urination can occur when there is a lower urinary tract obstruction. In the case of complications, frequent urination, urgency, incontinence, secondary urination, hematuria, and turbid urine may occur. Diagnosis According to the clinical symptoms, the size and position of the diverticulum and diverticulum can be seen under cystoscopy. At the same time, attention should be paid to the presence or absence of complications such as lower urinary tract obstruction, stones, tumors, infection and bleeding. Cyst angiography can show the size and location of the diverticulum, the emptying time of the contrast agent, and the presence or absence of ureteral reflux. Before treatment, the following questions should be clarified: 1 whether there is lower urinary tract obstruction; 2 size, location, single or multiple sacral diverticulum; 3 whether it is a sputum-type diverticulum that can not be emptied; 4 with or without stones, tumors, infection and bleeding 5; with or without upper urinary tract obstruction and lesions. The principle of treatment is that the small non-retention type, uncomplicated bladder diverticulum does not require surgery, but the lower urinary tract obstruction is relieved. Surgical treatment is required for larger retention or complication of the bladder diverticulum. Surgical methods are generally preferred for intravesical diverticulum resection. If the wall of the iliac crest is adhered, the extracorporeal diverticulum is removed. If the diverticulum affects the ipsilateral ureter and its opening, ureteral bladder replantation is required. If the tumor is complicated in the room, partial cystectomy or total cystectomy should be performed as appropriate. Treatment of diseases: bladder diverticulum Indication 1. Larger extraluminal diverticulum. 2. Extra-bladder diverticulum with complications such as infection, bleeding, stones and tumors. Preoperative preparation 1. Infected patients apply antibiotics before surgery, and indwell the bladder with antibiotic solution after instillation of the catheter, and then perform surgery after infection control. 2. Indwelling the catheter before surgery, injecting isotonic saline to fill the bladder. If there is a tumor, an anticancer drug such as mitomycin C should be injected. Surgical procedure 1. Incision The midline incision in the lower abdomen 2. Reveal the diverticulum to open the bladder, free diverticulum, expose the diverticulum and diverticulum. Exploring the presence or absence of lower urinary tract obstruction, and observing the relationship between the diverticulum and the ureteral orifice, and inserting a ureteral catheter if necessary. Crossed from the incision of the bladder to the mouth of the bladder. Free bladder diverticulum. 3. Diverticulum removal After the diverticulum is freed, the diverticulum is removed at the diverticulum opening. 4. After suturing the wound with the bladder, the bladder incision was continuously sutured with the absorbable line of 2-0, and the suture was sutured with the No. 0 silk thread. There are two ways of suturing: one is to suture the bladder incision obliquely, and the other is placed on the top of the bladder to place the F26 sputum catheter as the bladder stoma, and the ostomy tube is sewn with absorbable lines on both sides. Preventing prolapse. Another way is to make the T-shaped suture of the bladder incision, and insert the F26 sacral catheter into the top of the bladder incision for the bladder stoma. After the bladder was sutured, 200 ml of isotonic saline was injected from the stoma tube, and the suture was observed for leakage. If so, the needle was sutured. 5. Place the drainage again After flushing the wound, place a rubber tube drainage in the posterior pubic space or at the diverticulum resection. The abdominal incision is sutured layer by layer. The skin suture is used to fix the bladder stoma. complication 1. Bleeding is mainly due to imperfect hemostasis during diverticulum resection. The lighter keeps the bladder slewing and continues to flush to prevent the formation of blood clots and block the pipeline. In severe cases, the hemorrhage block was used to rush the hemorrhage block, and the electrocoagulation was stopped under direct vision, and the blood was transfused. 2. The infection is mainly caused by the infection of the preoperative diverticulum and the lack of anti-infection preparation before surgery. The prevention method is to strengthen preoperative anti-infection preparation, select broad-spectrum, sensitive and effective antibiotics for systemic and topical application. If infection has occurred, in addition to strengthening the application of antibiotics, the bladder should be kept flowing smoothly, the wound should be fully drained, and foreign objects such as silk thread in the wound should be removed in time. 3. The ureteral injury was mainly due to the lack of attention to the relationship between the diverticulum and the ureteral orifice. The ureteral catheter was not placed before the diverticulum resection. The preventive measures are such that the diverticulum is close to the ureteral orifice or the posterior wall of the bladder. The ureteral catheter must be placed before the diverticulum is removed. If a partial ureterotomy has occurred, immediately suture with a 4-0 absorbable line and place the ureteral stent tube for 2 weeks. If the ureter has been cut, the 4-0 absorbable line is used to make a scoop-shaped end-to-end anastomosis, and the ureteral stent tube is left for 3 weeks.