Treatment of Urinary Bladder Diverticulum
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Urinary bladder diverticulum is a pouch on the wall of the bladder. There are congenital and acquired forms of this disease. In 80% of cases, this disease develops in childhood. It usually manifests itself in difficult urination and pain in the bladder. Typically, diverticulum forms on rear walls of the urinary bladder. The pouch is usually small and it rarely has dimensions that exceed the volume of the bladder. In men, bladder diverticulum develops 10 times more often than in women. Usually it happens after a man has had prostate disease.
Depending on the number of additional cavities, there can be single or multiple pouches. In structure there are true and false forms of diverticulum. True diverticulum is formed by multiple layers of mucosa and submucosa. False diverticulum is formed only by mucous layer of the bladder, which protrudes forward and is visible from the outside like a hernia.
Congenital diverticulum can be the result of inborn bladder anomalies that cause the bladder to become weak. Acquired diverticulum can develop due to long-term increase of intravesical pressure. Intravesical pressure is most often caused by bladder obstruction or by prostate cancer. It can also be caused by urethral stricture and bladder neck sclerosis. In some cases, [comma] diverticulum is caused by a long-term dysfunction of urine flow. Strenuous physical activities and weight lifting can contribute to gradual weakening and stretching of the bladder wall. Medical website Rightdiagnosis.com talks about a previously unknown cause of diverticulum, Ehlers-Danlos syndrome, which is a congenital disease of connective tissue. Overall, causes of this disease are:
- Weakness of the bladder wall
- Increased intravesical pressure
- Excessive stretching of the bladder wall
- Prostate adenoma
- Urethral stricture
- Long-term straining during urination
If not treated, diverticulum can be complicated by such diseases as:
- Cystitis
- Urolithiasis
- Pyelonephritis
- Stagnation of urine
- Formation of stones
- Hydronephrosis, kidney disease
- Urination that occurs in two stages - first, urine flows out of the bladder and then from the diverticulum
- Pain in pelvis
- Duration of urination increases
- There can be complete retention of urine
- Urine can flow back to kidneys
If a person has stagnation of urine, he can experience intoxication, dizziness, weakness and nausea. A person can develop stagnation if they have received no appropriate treatment for diverticulum or if they have stones or a kidney tumor.
- Detection of bladder diverticulum often occurs during routine physical examination at a urologist. Usually, people who have diverticulum also develop cystitis and pyelonephritis, which is why diverticulum is found while treating other urinary diseases.
- During cystography, the bladder is filled with a radiopaque substance which shows if there are any pouches on the bladder and, if so, their size and number.
- Cystoscopy shows the isthmus that connects the bladder to the diverticulum. If a cystoscope cannot freely enter the diverticulum cavity, it is an indicator that there are probably some benign or malignant formations, which can either be a diverticulum or a tumor.
- Sonography (ultrasound) assessment helps to identify the location, size and shape of a diverticulum and indicate the presence of tumors or stones.
If the diverticulum is small, it does not cause any recurrent inflammation. In this case a patient can simply undergo dynamic supervision at urologist.
During surgical resection a surgeon makes an incision and removes the pouch on the bladder wall. Surgery is performed through a suprapubic incision. After the pouch is resected, the wound is sutured in layers and drained. Endoscopy uses a camera, which also helps a surgeon remove the pouch. In the post-operative period, doctors also perform continuous bladder catheterization.
Treatment of diverticulum is in most cases solely surgical, because conservative and pharmacological methods are not able to stop irreversible protrusion of the bladder wall. However, it should be noted that the decision to have surgery must be made only after a thorough examination, because symptoms of diverticulum can sometimes be very similar to those of another disease entirely. Sometimes a simple urine inflammation can cause the same symptoms as diverticulum, although inflammation is less severe and a less dangerous disease than diverticulum. Inflammation can also be treated with simple medication, while diverticulum can’t.
In general, indications for surgery are:
- Diverticulum is of considerable size
- Diverticulum compresses adjacent organs
- Risk of additional bacterial microflora
- Presence of stones in the diverticulum
- Risk of developing kidney stones
- Presence of tumors
Authors: Dr. Nadezhda Ivanisova, Dr. Farrukh Ahmed