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Saudi Journal of Kidney Diseases and Transplantation
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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 3  |  Page : 474-475
Bilateral large diverticulae of urinary bladder


Department of Surgery, Subharti Medical College, Meerut, India

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How to cite this article:
Pandey S, Agarwal V, Mishra S, Thakur S K. Bilateral large diverticulae of urinary bladder. Saudi J Kidney Dis Transpl 2009;20:474-5

How to cite this URL:
Pandey S, Agarwal V, Mishra S, Thakur S K. Bilateral large diverticulae of urinary bladder. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Nov 29];20:474-5. Available from: https://www.sjkdt.org/text.asp?2009/20/3/474/50784

   Introduction Top


Bladder diverticulum is an outpouching of the mucosa through the muscular wall of the bla­dder, which may be congenital or acquired. Bladder diverticulae in children and adults is reported to be approximately 1.7% and 1 to 6% respectively. [1] In adults, most often they occur as a result of outlet obstruction, frequently prostatic hypertrophy. Occasionally, when a diverticulum encompasses the ureteral orifice in the setting of a neurogenic bladder and vesico-ureteral reflux, it is termed a "Hutch" diverticulum. [1]


   Case Report Top


A 65 year old male presented with increased diurnal frequency and difficulty in micturition, frequent attacks of urinary tract infection and episodes of near retention for the last one and half years. Clinically he had prostate enlarge­ment on per-rectal examination. Plain X-ray KUB revealed multiple calculi in the pelvic region. Ultrasonography confirmed the pre­sence of multiple bladder calculi with bilateral large diverticulae, enlarged prostate, and sig­nificant residual urine with out hydronephro­sis. Intravenous urography with voiding cysto­graphy revealed two large diverticulae on either side of normal ureters with multiple cal­culi in bladder and diverticulae [Figure 1].

Preoperative Cystoscopy revealed enlarged prostate, trabeculations and sacculations with cystitis and bilateral narrow opening of diver­ticulae superolateral to ureteric orifices. Bila­teral ureteric stenting was done peroperatively with combined intravesical and extravesical diverticulectomy accompanied by removal of stones and packing of diverticulum. Suprapubic transvesical enucleation of prostate was also done. Glycine irrigation through Foley's triway catheter continued for 48 hours with unevent­ful post-operative period. Prevesical drain was removed on 4 th and Foley's catheter removed on 14 th post-operative day.


   Discussion Top


Bladder diverticulae can be congenital or ac­quired. Acquired diverticulae are of two types­pulsion or traction type. Acquired diverticulae are rare in women. Congenital bladder diverti­culae is usually solitary and seen in boys younger than 10 years. On Cystoscopy, smooth walled bladder is seen. Causes could be as follows- congenital weakness at the level of ureterovesical junction; aberrant voiding dyna­mics or anatomy as in Prune-belly syndrome or posterior urethral valve where diverticulum is usually located at the dome of bladder. This variety is also associated with various conge­nital syndromes such as Menke's syndrome, William's syndrome and  Ehlers-Danlos syndrome More Details. [1]

Acquired bladder diverticulum usually occurs in males more than 60 years of age. Diverti­culae are often multiple and usually occur on the lateral bladder walls On Cystoscopy, there are usually multiple openings with significant bladder trabeculations. Causes could be a bla­dder outlet obstruction, neurogenic vesico-ure­thral dysfunction or Iatrogenic. [1],[2] Large diver­ticulae often displace the bladder and/or ure­ters. Diverticulae narrow necks are slow to empty and likely to have urinary stasis and infection. [2] Repeated infections, hematuria due to stone in the diverticulum and passing of urine twice, once from the bladder, followed by emptying of the diverticulum (Pis en deux) are the usual presenting features. Metaplasia and tumor can also occur in the diverticulum with a like­lihood of spread beyond the bladder since the diverticulum wall consists only of urothelium without muscle. [1],[3],[4]

Bladder diverticulae can be evaluated with excretory urography with pre- and post-void films, Ultrasonography, CT scan and Cystos­copy. [1] Indications for surgery in a case of bladder diverticulum include- persistent or recu­rrent urinary infection, presence of stones in a diverticulum, development of tumor in a diver­ticulum, lower urinary tract symptoms, voiding dysfunction and vesicoureteral reflux due to diverticulum or ureteral obstruction. [1],[2]

Small size diverticulum resolves with relief of bladder outlet obstruction wheras surgery is needed in large size diverticulum if sympto­matic. Surgical options include transurethral cystoscopic or open surgical management by either Transvesical or combined extravesical and intravesical approach or Tubeless diverti­culectomy either by Laparoscopic or trans-abdominal approach. [1],[2],[3],[4]


   Acknowledgement Top


We are thankful to the medical superintendent Subharti Medical College, Meerut, for giving us the permission to publish this case report.

 
   References Top

1.Wein AJ, Kavoussi LR, Novick AC. Campbell­Walsh, Urology 9th Edition, 2006 W.B. Saunders: 2361-2371.  Back to cited text no. 1    
2.Faramarzi-Roques R, calvet C, Gataeu T, Ballanger PH. Surgical treatment of bladder diverticula: laparoscopic approach.. J Endourol 2004;18(1):69-72.  Back to cited text no. 2    
3.Pizzi P, Castillo O, Carvajal D, Vitagliano G, Hidalgo F. Transperitoneal laparoscopic bladder diverticulectomy. Arch Esp Urol 2006;59(8): 805-8.  Back to cited text no. 3    
4.Abdel-Hakim AM, El-Feel A, Abouel-Fettouh H, Saad I. Laparoscopic vesical diverticulectomy. J Endourol 2007;21(1):85-9.  Back to cited text no. 4    

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Correspondence Address:
S K Thakur
Department of Surgery, Subharti Medical College, Delhi-Haridwar Bypass Road, Meerut- 250002
India
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PMID: 19414956

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    Figures

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    Introduction
    Case Report
    Discussion
    Acknowledgement
    References
    Article Figures
 

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