Hutch diverticulum is a rare form of diverticulum that arises from the compromised muscular development at the ureteral orifice. It is a congenital and rare bladder disease in adults that can be either symptomatic or asymptomatic and relies on imaging for diagnosis and preoperative planning. Indications for surgery are dependent on complications from the diverticulum. Tumor bladder within Hutch diverticulum is extremely rare with no reported cases.
Herein, we present the first video-report of bladder cancer within the Hutch diverticulum managed by NIRF guided robot-assisted diverticulectomy & ureteral reimplantation.
We report a case of a 71-year-old man with BMI of 27.5, ASA score of 3, HTN, and BPH that was hospitalized for macroscopic hematuria. Preoperative CT urogram showed a large diverticulum at the level of the left ureterovesical junction, with associated eccentric and enhancing soft tissue/lobulated wall thickening, consistent with a tumor. The diverticulum measured approximately 2.5 x 2.1 x 2.3 cm, and was inseparable from the distal left ureter. NIRF guided robot-assisted diverticulectomy & ureteral reimplantation was performed. A 6 ports configuration was adopted, similar to robotic radical prostatectomy. In the present video, we show the key surgical steps of the procedure.
The total operative time and the estimated blood loss was 257 min and 35 ml, respectively. Continuous bladder irrigation was used for 24 hours. The drain was removed on a postoperative day (POD) 1. The patient was discharged home on POD 2 with stent in place that was removed on POD 26. Histology showed high-grade T1 bladder cancer located in the left Hutch diverticulum with negative margins.
In conclusion, bladder tumor within Hutch diverticulum is a rare pathology of the bladder. We report a successful NIRF guided robot-assisted diverticulectomy & ureteral reimplantation for bladder tumor within Hutch without any significant complications.