Bladder diverticulum is the herniation of bladder mucosa through a weakened area of the muscularis propria and may arise from either congenital or acquired etiologies. Acquired bladder diverticulaa re more commonly observed in males over the age of 60, particularly in individuals with bladder outlet obstruction or neurogenic dysfunction. The clinical presentation of bladder diverticula is often nonspecific, making diagnosis challenging. They are frequetly detected incidentally during the evaluation of patients presenting with lower urinary tract symptoms, hematuria or recurrent urinary tract infections.

We herein report a case of a large bladder diverticulum in a 69-year-old male who initially presented with lower urinary tract symptoms, including frequency, nocturia, weak stream and a sensation of incomplete emptying persisting for several months. These symptoms closely resembled those of benign prostatic hyperplasia with bladder outlet obstruction. The patient underwent transurethral resection of prostate. During the endoscopic procedure, a large bladder diverticulum was incidentally identified. Post-operatively, the patient’s symptoms of frequency, nocturia and weak stream improved; however, the sensation of incomplete emptying persisted. Urine analysis revealed persistent pyuria, and abdominaland pelvic computed tomography demonstrated a sizable bladder diverticulum on the right lateral bladder wall, accompanied by chronic cystitis. Given the symptoms associated with poor emptying of the diverticulum and urinary stasis, surgery intervention was indicated. The patient subsequently underwent robotic-assisted bladder diverticulectomy via a transperitoneal extravesical approach.

The procedure was successfully performed using a robotic-assisted approach without the need for conversion to open surgery. Post-operatively, the patient demonstrated minimal post-void residual volume and experienced significant improvement in the sensation of incomplete bladder emptying.

Robotic-assisted bladder diverticulectomy is a safe and effective minimally invasive approach for the management of large bladder diverticula.