Pneumovesicoscopic Diverticulectomy for Symptomatic Paraureteral Bladder Diverticulum in a Child

Abstract

Clinical History:

A 9-year-old boy presented with recurrent urinary tract infections and intermittent hematuria. Ultrasonography revealed a large bladder diverticulum arising from the right posterolateral wall. Voiding cystourethrography confirmed the diagnosis and excluded urethral anomalies or vesicoureteral reflux.

Physical Exam:

No abdominal masses or palpable bladder abnormalities were noted. The patient was otherwise healthy with normal physical development.

Diagnosis:

Symptomatic congenital paraureteral bladder diverticulum.

Intervention:

Under general anesthesia and lithotomy positioning, cystoscopy confirmed the diverticulum, and a double-J stent was placed in the right ureter. The bladder was fixed to the anterior abdominal wall using percutaneous sutures, and a 5-mm trocar for the optic and two 3-mm trocars for the instruments were inserted under cystoscopic guidance. After repositioning the patient to supine, CO₂ was insufflated into the bladder and maintained at 5 mmHg with a flow of 1.5 L/min. The diverticulum was inverted, dissected, and resected using a monopolar hook. The bladder defect and port sites were closed with interrupted absorbable sutures.

Follow-up/Outcomes:

The patient was discharged on postoperative day one with a Foley catheter, which was removed on day 7. Postoperative ultrasound and VCUG were normal. At 1-year follow-up, the patient remains asymptomatic with no recurrence.

Patient Consent Statement:

The authors have received and archived written informed consent for video recording and publication from the patient’s legal guardians.

This video was previously presented in abstract form and shown at several scientific meetings: the SECLA Congress (Bilbao, 2023), the CAU/SIUP Congress (Santiago, 2023), the ESPU Congress (Naples, 2024), the ESPES Congress (Strasbourg, 2024), and the SECP Congress (Tenerife, 2024). It was awarded Best Video at the 61st Annual Congress of the Spanish Society of Pediatric Surgery – SECP (Tenerife, 2024).

Conflict of Interest Statement:

The authors declare no conflicts of interest.

Runtime of video: 3 mins 46 secs.