Ureteral obstruction following transurethral resection of bladder cancer within the Hutch's diverticulum.

Here, we report a rare case of bladder cancer within the left congenital periureteral diverticulum, termed the Hutch's diverticulum. Following transurethral resection of the bladder tumor, repeated pyelonephritis was caused by stricture of the diverticulum orifice and ureter. We attempted transurethral dilation and ureteral stenting, but the obstruction did not improve. The patient's renal dysfunction showed gradual progression due to recurrent left pyelonephritis as well as the ureteral obstruction. Therefore, we finally performed a partial cystectomy, involving stricture and ureteral reimplantation. No tumor recurrence was observed over 39 months, and renal dysfunction did not progress following partial cystectomy.

A novel endoscopic approach for management of hutch diverticulum concomitant vesicoureteral reflux with dextranomer/hyaluronic acid copolymer injection.

INTRODUCTION: There are various treatment options for symptomatic bladder diverticulum, including robotic-assisted laparoscopic bladder diverticulectomy, open and endoscopic techniques. But, to date, the optimal surgical technique remains unclear. OBJECTIVE: To present the preliminary long-term follow-up results of a novel technique of dextranomer/hyaluronic acid copolymer (Deflux) plus autologous blood injection for correction of hutch diverticulum in patients with concomitant vesicoureteral reflux (VUR). PATIENT AND METHOD: We retrospectively reviewed four patients who had hutch diverticulum with concomitant VUR and had undergone submucosal Deflux following autologous blood injection. Patients with neurogenic bladder, posterior urethral valve, or voiding dysfunction were excluded from the study. Success was defined as the resolution of the diverticulum, hydronephrosis, and hydroureter on ultrasonography at a 3-month follow-up and long-term symptom-free period. RESULTS: Four patients with hutch diverticula were included. The median age at the time of surgery was 6.1 (range 3-8) years. Three of them had unilateral VUR, and one had bilateral VUR. During the procedure, a mean of 0.625 ml Deflux plus a mean of 1.25 ml autologous blood were injected submucosally for correction of VUR. Additionally, a mean of 1.62 ml Deflux plus a mean of 1.75 ml autologous blood were injected submucosally to occlude the diverticulum. The median follow-up was 4.6 (range 4-8) years. This method had excellent success in all patients in the current study with no postoperative complications such as febrile urinary tract infection, or diverticulum, hydroureter, or hydronephrosis in follow-up ultrasounds. CONCLUSIONS: Submucosal injection of Deflux plus autologous blood injection can be a successful endoscopic intervention for treatments of hutch diverticulum in patients with concomitant VUR. Deflux injection can be a simple and cost-effective technique.

Bilateral ureteric re-implant for an 18 months old boy with a huge bilateral hutch diverticulum presented with recurrent urinary retention.

Huge bladder diverticulum is uncommon but serious cause of obstructive uropathy in children. This study investigated an 18 months old boy with a huge bilateral Hutch diverticulum presented with recurrent urinary retention, underwent bilateral bladder diverticulectomy. The operative management entailed meticulous reconstruction of the lower urinary tract. Post operatively the patient restored normal voiding dynamics, and he is on regular follow up. We are reporting this case due to its rarity and to share our experience with the management and outcome in such cases.

Bilateral Hutch diverticula in an elderly male: Revelation of an unknown past.

Hutch diverticulum is a congenital diverticulum of the urinary bladder, reported infrequently in children and rare amongst adults. We present a 60-year-old male patient with bilateral Hutch diverticula, detected incidentally during an abdominal ultrasound examination performed for blunt abdominal trauma. This rare case highlights an unusual incidental presentation and opportunity to learn how to differentiate it from acquired bladder diverticula. The available treatment options are also discussed varying from simple follow-up to aggressive surgery.

Divertículo de Hutch assintomático no adulto / Asymptomatic Hutch diverticulum in adult

O divertículo paraureteral de Hutch é uma alteração incomum do sistema urinário, geralmente associadocom retenção urinária aguda e infecções recorrentes, além de refluxo vesicoureteral. Descrevem os autores um caso de divertículo de Hutch, incidentalmente encontrado em homem etilista de 36 anos, durante a investigação de um episódio de pancreatite aguda. Os estudos de ultra-sonografia e tomografia computadorizada do abdome revelaram uma imagem paraureteral característica de divertículo de Hutch. O paciente não apresentou sintomas urinários, e os exames complementares descartaram retenção urinária e refluxo vesicoureteral. O divertículo foi classificado como congênito, e o paciente tem sido acompanhado no ambulatório da Unidade de Urologia, sem queixas relacionadas ao trato urinário. O propósito deste relato é ilustrar a ocorrência de divertículo de Hutch em adultos assintomáticos.

Hutch paraureteral diverticulum is an unusual abnormality of the urinary system, usually associated with acute urinary retention and recurrent infections, in addition to vesico-ureteral reflux. We describe a case of Hutch diverticulum, which was incidentally found in a 36 year-old alcoholic male during the investigation for an acute episode of pancreatitis. Abdominal ultrasonography and co mputed tomographic studies revealed a paraureteral image typical of the Hutch diverticulum. The patient did not present urinary symptoms, and the complementary evaluation ruled out both urinary retention and vesico-ureteral reflux. The diverticulum was classified as congenital, and the patient has been followed on the Urology clinics without any urinary complain. The aim of this report is to illustrate the occurrence of Hutch diverticulae in asymptomatic adults.