INTRODUCTION AND OBJECTIVES: most pediatric bladder diverticula are small, localized in a paraureteral situation and its clinical significance associated with vesicoureteral reflux (VUR). Big bladder diverticula in the absence of VUR or lower urinary obstruction are rare in this age group and its treatment usually performed by open surgery either with a trans or extra-vesical approach. We present a case of a giant symptomatic bladder diverticulum in a boy treated vesicoscopically.

METHODS: We present a video demonstrating our technique of vesicoscopic diverticulectomy. The patient is a 6 year-old boy with irritative bladder symptoms and a giant left paraureteral diverticulum and no VUR. Cystoscopy, pneumovesicoscopy and bladder anchoring to the anterior abdominal wall were performed at the beginning of the case. Three ports (4mm (1), 3mm (2)) were placed in the midline hypogastrium under cystoscopic view. Diverticular resection, detrusor and mucosal closure were performed vesicoscopically with regular 3 mm laparoscopic instruments. Specimen removal was performed through the urethra. Trocar sites closure is discussed.

RESULTS: The procedure was successfully performed with negligible blood loss in 250 minutes. Postoperative course was uneventful. There was no need for narcotics or anticholinergic medications for pain or bladder spasms control. Patient was discharge home on postoperative day 3 when the Foley catheter was removed with no need for pain medication. There were no intra or postoperative complications. Patient remains asymptomatic with normal radiologic studies at 2 years of follow up.

CONCLUSIONS: Different alternatives of minimally invasive surgery are expanding in the pediatric age group. In our experience, vesicoscopy was a safe reliable and effective way to treat a giant bladder diverticulum.

Source of Funding: NONE