Bladder diverticula management - conservative and surgical outcomes: a narrative review from EAU endourology.

IF 2.2 3区 医学 Q2 UROLOGY & NEPHROLOGY
Davide Perri, Jean-Baptiste Roche, Bogdan Petrut, Giorgio Bozzini
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引用次数: 0

Abstract

Purpose of review: Standardized treatment of bladder diverticula is not defined. The majority of evidence comes from single-centre case series and high-quality studies are lacking.

Recent findings: Surgery is the preferred option to treat a symptomatic bladder diverticulum. Robot-assisted surgery has progressively replaced open approach, either with an extravesical or transvesical or transdiverticular technique, with favourable outcomes. Endoscopic treatment may represent a valid alternative mainly in old and frail patients. In case of intradiverticular tumour, some concerns arise on the optimal management between transurethral resection, partial and radical cystectomy. Pathological evaluation may underestimate the oncological status given the lack of muscular layer in the diverticular wall.

Summary: Surgical diverticulectomy is considered the reference option for symptomatic diverticula. Robotics should be the preferred approach whenever available. Whatever the technique used (extravesical, transvesical, transdiverticular), good outcomes have been reported. Alternatively, endoscopic incision of diverticular neck and fulguration of the mucosa may be considered for selected patients. The relationship between bladder diverticula and bladder cancer is unclear and the choice between transurethral resection, partial or radical cystectomy should be based on multiple factors, starting from tumour stage and grade. However, evidence comes mainly from limited, heterogeneous case-series. Further studies are needed to properly assess the management of these patients.

膀胱憩室治疗-保守和手术结果:来自EAU泌尿外科的叙述回顾。
综述目的:膀胱憩室的标准化治疗尚未明确。大多数证据来自单中心病例系列,缺乏高质量的研究。最近发现:手术是治疗症状性膀胱憩室的首选方法。机器人辅助手术已逐渐取代开放入路,无论是体外或经膀胱或经憩室技术,都有良好的结果。内窥镜治疗可能是一个有效的选择,主要是在老年人和虚弱的病人。对于垂直肿瘤,经尿道膀胱切除术、部分膀胱切除术和根治性膀胱切除术之间的最佳处理方式引起了人们的关注。由于憩室壁缺乏肌肉层,病理评估可能低估肿瘤状况。摘要:手术憩室切除术被认为是治疗症状性憩室的参考选择。只要有可能,机器人技术应该是首选的方法。无论采用何种技术(体外、经膀胱、经憩室),均有良好的疗效报道。对于特定的患者,也可以考虑内镜下切开憩室颈部和灼烧粘膜。膀胱憩室与膀胱癌的关系尚不清楚,选择经尿道膀胱切除术、部分或根治性膀胱切除术应从肿瘤分期和分级出发,综合考虑多种因素。然而,证据主要来自有限的异质病例系列。需要进一步的研究来正确评估这些患者的管理。
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来源期刊
Current Opinion in Urology
Current Opinion in Urology 医学-泌尿学与肾脏学
CiteScore
5.00
自引率
4.00%
发文量
140
审稿时长
6-12 weeks
期刊介绍: ​​​​​​​​Current Opinion in Urology delivers a broad-based perspective on the most recent and most exciting developments in urology from across the world. Published bimonthly and featuring ten key topics – including focuses on prostate cancer, bladder cancer and minimally invasive urology – the journal’s renowned team of guest editors ensure a balanced, expert assessment of the recently published literature in each respective field with insightful editorials and on-the-mark invited reviews.
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