Progress in the treatment of bladder diverticulum / 中华泌尿外科杂志

Bladder diverticulum is a hernia formed by the protrusion of the mucosa through the weak muscularis propria of the bladder wall. It can be divided into congenital and acquired. Most patients are asymptomatic, and be found by physical examination or incidentally during the diagnosis and treatment of other diseases. The majority of bladder diverticula occur in male patients, mostly due to lower urinary tract obstruction. Severe diverticula may cause recurrent urinary tract infection or even malignant transformation, which requiring surgical treatment.

Asymptomatic Bladder Diverticulum Can Develop New Urinary Symptoms after a New Onset of Stroke: a Case Report

Bladder diverticulum can be caused by many varying factors. It is usually asymptomatic in nature and thus often found by chance. In adult males, it can develop as a result of increased intravesicular pressure in the presence of an underlying benign prostatic hyperplasia. We observed a case in which a patient with asymptomatic bladder diverticulum developed new urinary symptoms owing to an underlying neurogenic lower urinary tract disorder which occurred following a cerebral infarction.

The role of bladder diverticula in the prevalence of acute urinary retention in patients with BPH who are candidates to surgery

ABSTRACT Introduction: The urinary bladder diverticula (BD) secondary to benign prostatic hyperplasia (BPH) is a complication that can lead to urinary stasis, stone, urinary tract infection (UTI) and tumors. It's role in acute urinary retention (AUR) is not totally understood. Objectives: To determine the effect of BD size on AUR rates in patients with BPH candidates to surgery. Subjects and Methods: We performed a retrospective cohort study of 47 patients with BPH and BD who underwent BPH surgery associated to complete bladder diverticulectomy from 2006 to 2016. We analyzed risk factors for AUR in patients with BD using univariate, multivariate and correlation analysis. Results: There was a difference in the size of the diverticula, with 6.8 cm vs. 4.5 cm among patients with and without AUR respectively (p=0.005). The ROC curve showed a correlation between the size of BD and the risk of AUR. The value of 5.15 cm presented a sensitivity of 73% and a specificity of 72%. The area under the curve was 0.75 (p=0.01). Comparing groups with BD >5.0 cm vs. ≤5.0 cm, the AUR incidence was 74% and 27.8% respectively with an OR of 2.65 (1.20-5.85) (p=0.005). In the multivariate analysis, only the size of the diverticula reached statistical significance (p=0.012). Conclusions: The diameter of BD is an independent risk factor for AUR in patients with BPH and BD who are candidates to surgery. A diameter greater than 5.15 cm increases the risk of AUR.

Diverticulitis vesical: reporte de un caso y revisión de la literatura / Bladder diverticulitis: case report and literature review

Se presenta un caso de diverticulitis vesical en un paciente de 60 años con antecedente de obstrucción crónica al tracto de salida vesical (estenosis uretral), quien consulta por dolor pelviano inespecífico. Por lo anterior se realiza Resonancia Magnética (RM) de pelvis, que demuestra la presencia de un divertículo vesical de pared engrosada con cambios inflamatorios, los que comprometen además, la grasa peri-vesical. Este divertículo había sido detectado en RM pelviana un año antes. Se comenta el caso clínico, sus hallazgos a la RM y revisión de la literatura...

We report a case of bladder diverticulitis in a 60 years old patient with a history of chronic lower urinary tract obstruction (urethral stricture), who consulted for nonspecific pelvic pain. Pelvic magnetic resonance imaging (MRI) was obtained, demonstrating the presence of a bladder diverticulum with a thick wall and inflammatory changes involving the perivesical fat. The diverticulum had been detected on pelvic MRI a year earlier. We discuss the clinical case, the MRI findings and a review of the literature....

Spontaneous Rupture of a Bladder Diverticulum: A Case Report

We report on a case of spontaneous rupture of a bladder diverticulum, along with its cystographic and CT findings, in a 36-year-old woman. Three dimensional reformation of CT scanning is helpful for detecting the definite perforation site. To our knowledge, there has been no such report in the radiology literature describing the spontaneous rupture of a bladder diverticulum.

Clinical Analysis of Urachal Anomalies

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.

Clinical Analysis of Urachal Anomalies

PURPOSE: Although urachal anomalies are rarely observed clinically, they often give rise to a number of problems, such as infection and late malignant changes. Because of variable clinical presentations, uniform guidlines for evaluation and treatment are lacking. The authors discuss the problems involved in both the diagnosis and the treatment of these anomalies. METHODS: We retrospectively analyzed 15 patients (9 males and 6 females) who had undergone surgery for urachal anomalies from July 1995 to December 1999. RESULTS: The age distribution ranged from 14 days to 38 years old, and the male to female ratio was 1.5:1. The 4 variants of urachal anomalies included a urachal sinus in 7 patients (47%), a urachal cyst in 4 (27%), a patent urachus in 3 (20%), and a bladder diverticulum in 1 (6%). The presenting complaint was periumbilical discharge in 6 patients, fever in 5, umbilical granuloma in 4, low abdominal mass in 3, and low abdominal pain in 1. Eight combined anomalies were seen in 7 patients; 2 umbilical hernias, 1 inguinal hernia, 1 hydrocele, 1 urachal vessel anomaly, 1 vesicoureteral reflux, 1 hydronephrosis, 1 Hirschsprung's disease, and 1 hypertrophic pyloric stenosis. Ultrasound examination disclosed a cyst or a sinus in 5 patients, and CT was performed in 1 case. Excision was performed in all patients, and there was no postoperative complication or recurrence. CONCLUSION: Urachal anomalies most frequently present in infancy or childhood, and the initial presentation is umbilical discharge with infection. Furthermore, the large number of associated genitourinary and gastrointestinal anomalies suggests that a complete work-up for these conditions should be performed. Definitive surgical excision appears to be appropriate for most patients.

Megabladder and Bladder Diverticulum Associated With Ehlers-Danlos Syndrome in Female / 대한비뇨기과학회지

The Ehlers-Danlos syndrome is a congenital anomaly having collagen metabolism with clinical and genetic heterogeneity. It has been classified into ten distinct clinical forms. Urinary bladder diverticula associated with Ehlers-Danlos syndrome appear to be relatively rare and all of the reported cases were male. A 7 years old female patient with Ehlers-Danlos syndrome visited to our hospital because of gross hematuria after blunt trauma to lower abdomen. Markedly distended urinary bladder with diverticulum was found on abdominopelvic computed tomography. Upper tract was unremarkable. We report a 7 years old female patient with Ehlers-Danlos syndrome associated with megabladder and bladder diverticulum.

Vesicoureteral Reflux Secondary to a Simple Diverticulectomy: A Case Report / 대한비뇨기과학회지

A case of congenital periureteral bladder diverticulum is described. Bladder outflow obstruction and urinary tract infection were the presenting symptoms of a 2 year old boy. There were two diverticula in the bladder. The one was small (1 x 2cm) and located just above the right ureteral orifice and the other was large (8 x 10cm) and located at the left trigone. There was no hydronephrosis, and vesicoureteral reflux, neither. A simple diverticulectomy was performed. The left ureteral orifice was found at the medial side of the diverticulum's neck during operation. During follow up, bilateral high grade vesicoureteral reflux were discovered and urinary tract infections developed frequently. Eventually, ureteral reimplantation was done one year after the diverticulectomy.

A Case of Primary Transitional Cell Carcinoma in Bladder Diverticulum / 대한비뇨기과학회지

We report a case of primary transitional cell carcinoma developed in bladder vdiverticulum with brief review of literatures. Patient was a 71 year-old man who had painless gross hematuria for 10 days. Excretory urogram showe a large diverticulum in the bladder. At cystoscopy a 0.5 x 0.5cm sized papillary mass was seen on diverticular mucosa. Urine cytology revealed class V transitional cell carcinoma. At pelvic CT, metastatic evidence was not seen. We carried out partial cystectomy involving diverticulum under the diagnosis of primary transitional cell carcinoma developed in vesical diverticulum. The histopathologic diagnosis was grade III, stage A transitional cell carcinoma combining with carcinoma in situ.

Primary Transitional Cell Ca. Occurring in Vesical Diverticula / 대한비뇨기과학회지

Primary neoplasm in vesical diverticula has circumscribed sac of variable size which results from the herniation of bladder mucosa through the muscular will of the bladder. The incidence of neoplasm in vesical diverticulum is 2 to 10 percent. Specific diagnostic and therapeutic procedures are required for tumors in vesical diverticula. We herein report a case of primary neoplasms in vesical diverticula with brief review of literatures.

Squamous Cell Carcinoma in Bladder Diverticulum: A Report of One Case / 대한비뇨기과학회지

Primary neoplasms arising in vesical diverticulum are rare and present special problems in diagnosis. Early diagnosis and adequate treatment are stressed. We report one case of squamous cell carcinoma in bladder diverticulum with brief review of literature.

Bladder Diverticulum in an Infant: Report of a Case / 대한비뇨기과학회지

A 9 month-old male infant was admitted with the chief complaints of acute urinary retention and fever for 7 days. IVP showed the dilated upper urinary tracts. An expression cystogram demonstrated a bladder diverticulum without ureteral reflux. On cystoscopy, the left ureteral orifice was thought to be engulfed by the diverticulum and could not be seen The right ureteral orifice was normal findings. Diverticulectomy and left ureteroneocystostomy were performed. Postoperative course was uneventful and postoperative voiding cystography and IVP one month later showed an improvement of the upper urinary tracts. Diverticulum of the bladder it an infant was discussed.