Robotic bladder diverticulectomy in patients with bladder diverticulum neoplasia: a single-center study

Authors

  • Roberto Falabella Urology Unit, San Carlo Hospital, Potenza
  • Angelo Porreca Department of Oncological Urology, Veneto Institute of Oncology IOV-IRCCS, Padua
  • Nazario Foschi Department of Urology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome
  • Antonio Salvaggio Humanitas-Istituto Clinico Catanese, Catania
  • Luca Digianfrancesco Department of Oncological Urology, Veneto Institute of Oncology IOV-IRCCS, Padua
  • Biagio Barone Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, Federico II University of Naples
  • Felice Crocetto Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, Federico II University of Naples
  • Vincenzo Francesco Caputo Urology Unit, San Carlo Hospital, Potenza; Department of Neurosciences, Sciences and Odontostomatology, Urology Unit, Federico II University of Naples https://orcid.org/0000-0002-9462-1427 (unauthenticated)

DOI:

https://doi.org/10.4081/aiua.2025.14467

Keywords:

bladder cancer, bladder diverticulum, diverticulectomy, robotic surgery

Abstract

Purpose: The aim of this work is to present the clinical experience and outcomes in the management and follow up of bladder diverticular neoplasm.
Methods: Following institutional board approval and informed consent obtained from each patient, a total of 10 patients, from January 2021 to December 2023, underwent robotic-assisted bladder diverticulectomy with the preservation of the bladder. All the cases were performed with a four port transperitoneal approach plus two laparoscopic ports for the second surgeon, opting for an extravesical dissection of the diverticular neck. A tailored follow up for each patient was planned with cytological examination, cystoscopy and imaging. All patients were screened to confirm localized disease and to exclude obstructive disease and LUTS to avoid high post voiding volumes.
Results: To date, all patients involved in the study have adhered to the follow up protocol and remain alive and free of recurrent disease. Catheters were successfully removed in all ten patients, after a negative cystography for leakage at seven days. Pathological examination confirmed clear surgical margins in 100% of the cases. The average length of the procedure was 112 minutes, with minimal blood loss and a mean hospital stay of 3,7 days. No major complication occurred.
Conclusions: Our case series demonstrated the safety and feasibility of this approach, achieving favourable operative times, minimal blood loss and absence of leakage. The outcomes also highlight improvement in terms of reduction of catheterization duration, hospital stay and QoL of the patients.

Downloads

Download data is not yet available.

References

1. Wang CK, Chueh SC. Case Report: laparoscopic partial cystectomy with endo-GIA stapling device in bladder diverticular carcinoma. J Endourol. 2007; 21:772-5.

2. Walker NF, Gan C, Olsburgh J, Khan MS. Diagnosis and management of intradiverticular bladder tumours. Nat Rev Urol. 2014;11:383-90.

3. Zhong H, George S, Kauffman E, et al. Clinicopathologic characterization of intradiverticular carcinoma of urinary bladder - a study of 22 cases from a single cancer center. Diagn Pathol. 2014; 9:222.

4. Matkovc A, Ferenc T, Jurjevic N, et al. Urothelial carcinoma in a urinary bladder diverticulum: A case report and review of the literature. Radiol Case Rep. 2023; 18:1169-1174.

5. Štimac G, Kneževic M, Grubišic I, et al. A rare case of squamous cell carcinoma in urinary bladder diverticulum successfully treated by bladder-sparing surgery. Acta Clin Croat. 2015; 54:363-6.

6. Grubišic I, Lenicek T, Tomas D, et al. Primary osteosarcoma of bladder diverticulum mimicking intradiverticular calculus: a case report. Diagn Pathol. 2011; 6:37.

7. Dong W, Ping Y, Liang W, et al. Small cell carcinoma of the urinary bladder diverticulum: A case report and review of the literature. J Cancer Res Ther. 2013; 9:151.

8. Matkovic A, Ferenc T, Jurjevic N, et al. Urothelial carcinoma in a urinary bladder diverticulum: A case report and review of the literature. Successfully trated Radiol Case Rep. 2023; 18:1169-74.

9. Davidiuk AJ, Meschia C, Young PR, Thiel DD. Robotic-assisted bladder diverticulectomy: assessment of outcomes and modifications of technique. Urology. 2015; 85:1347-51.

10. Giannarini G, Rossanese M, Macchione L, et al. Robot-assisted bladder diverticulectomy using a transperitoneal extravesical approach. Eur Urol Open Sci. 2022; 44:162-8.

11. Gibson D, Shanmugasundaram R, McClintock G, et al. Robotic-assisted bladder diverticulectomy: indications, technique, and outcomes - a case series. J Endourol. 2024; 38:1013-20.

12. Ploumidis A, Pappas A. Robotic-assisted bladder diverticulectomy. In: John H, Wiklund P, editors, Robotic Urology. Springer, Cham; 2024. p. 357-64.

13. Hagerty JA, Lindgren BW. Bladder diverticulum excision. In: Gundeti MS, editor. Pediatric robotic and reconstructive urology. 1st ed. Wiley; 2011. p. 193-8.

14. Altunrende F, Autorino R, Patel NS, et al. Robotic bladder diverticulectomy: Technique and surgical outcomes. Int J Urol. 2011;18:265-71.

15. Abdeen M, Siemer S. Complications after robotic bladder surgery. In: John H, Wiklund P, editors. Robotic urology. Springer, Cham 2024; p. 843-51.

16. Liu S, Pathak RA, Hemal AK. Robot-assisted laparoscopic bladder diverticulectomy: adaptation of techniques for a variety of clinical presentations. Urology. 2021; 147:311-6.

17. Ashton A, Soares R, Kusuma VRM, et al. Robotic-assisted bladder diverticulectomy: point of technique to identify the diverticulum. J Robot Surg. 2019; 13:163-6.

18. Tufek I, Mourmouris P, Argun OB, et al. Robot-assisted bladder diverticulectomy with concurrent management of bladder outlet obstruction. Urol Int. 2016; 96:432-7.

19. Myer EG, Wagner JR. Robotic assisted laparoscopic bladder diverticulectomy. J Urol. 2007; 178:2406-10.

20. Rao R, Nayyar R, Panda S, Hemal AK. Surgical techniques: robotic bladder diverticulectomy with the da Vinci-S surgical system. J Robot Surg. 2007; 1:217-20.

21. Matkovic A, Ferenc T, Jurjevic N, et al. Urothelial carcinoma in a urinary bladder diverticulum: A case report and review of the literature. Radiol Case Rep. 2023;18:1169-1174.

22. Falabella R, La Falce S, Ponti FC, et al. A rare case of muscle invasive bladder cancer in a vescical inguinal hernia. Urol Case Rep. 2024;53:102673.

Downloads

Published

24-12-2025

Issue

Section

Original Papers - Oncology

How to Cite

Robotic bladder diverticulectomy in patients with bladder diverticulum neoplasia: a single-center study. (2025). Archivio Italiano Di Urologia E Andrologia, 97(4). https://doi.org/10.4081/aiua.2025.14467