Bladder diverticulum

Introduction The bladder diverticulum is congenital and secondary, and the congenital bladder diverticulum wall contains muscle fibers. Acquired multiple secondary to urinary tract obstruction. Patients with bladder diverticulum die before the age of 10 and between 50 and 60 years old. If there is no complication, there is no special symptoms in the bladder diverticulum. If there is obstruction or infection, symptoms such as dysuria, frequent urination, urgency, and urinary tract infection may occur. Some diverticulum can be as large as 2000ml, which compresses the bladder neck and urethra, leading to lower urinary tract obstruction. There is no muscle contraction in the diverticulum, which leads to poor drainage of the urine. It is easy to be accompanied by ureteral bladder reflux. One or both sides of the hydronephrosis may occur, eventually leading to renal failure. But there are also congenital giant diverticulum without urinary tract obstruction. Due to the small amount of muscle fibers in the bladder diverticulum, during the urination, the urine in the sputum can not be discharged, and there is a secondary urination. Some patients have hematuria due to infection and stones in the sputum. A small number of patients may have urinary retention due to the huge diverticulum located in the bladder neck and compressing the bladder outlet, which may cause constipation and oppress the uterus and cause dystocia.

Cause

(1) Causes of the disease

Congenital lesions such as urethral stricture, posterior urethral valve, bladder neck contracture, obstruction promote the formation and development of diverticulum, which is the main factor of diverticulum production. Clinically, most patients with bladder neck obstruction do not have diverticulum, and some diverticulum cases do not have obstruction, so the formation of bladder diverticulum is also related to the congenital abnormality of bladder muscle fibers. Lower urinary tract obstruction and hypertension are the main causes of secondary bladder diverticulosis.

Clinically, the diverticulum is most common in the vicinity of the ureteral orifice. In embryogenesis, the bladder wall is different from the bladder triangle. It is considered that the weak connection between the triangle and the detrusor is related to the formation of the bladder diverticulum.

Bladder diverticulum can also occur in the blind end of the ureteral opening. Oriasa (1990) reported 2 cases of ureteral blind end leading to the ureter and bladder diverticulum.

Another type of bladder diverticulum is located in the neck, which may be associated with urinary tract dysfunction, often secondary to lower urinary tract obstruction or pear-shaped abdominal syndrome (Prune-belly syndrome).

(two) pathogenesis

Congenital diverticulum is often caused by excess ureteral buds and patent urethral catheters, and congenital bladder wall muscle weakness. The diverticulum is mostly single, the wall of the diverticulum contains the full layer of the bladder, more common in children, under No urinary obstruction. The bladder diverticulum can also be caused by secondary factors, mostly due to lower urinary tract obstruction, and the bladder wall secondary to the lower urinary tract obstruction from the splitting of the detrusor muscle bundle to form a diverticulum, often multiple, There are mucosal trabeculae on the wall of the diverticulum (this type of diverticulum does not contain all layers of the bladder wall, so it is also called pseudo-diverticulum), more common in adult males, and there is detrusor hyperplasia.

an examination

If there is no complication, there is no special symptoms in the bladder diverticulum. If there is obstruction or infection, symptoms such as dysuria, frequent urination, urgency, and urinary tract infection may occur. Some diverticulum can be as large as 2000ml, which compresses the bladder neck and urethra, leading to lower urinary tract obstruction. There is no muscle contraction in the diverticulum, which leads to poor drainage of the urine. It is easy to be accompanied by ureteral bladder reflux. One or both sides of the hydronephrosis may occur, eventually leading to renal failure. But there are also congenital giant diverticulum without urinary tract obstruction. Due to the small amount of muscle fibers in the bladder diverticulum, during the urination, the urine in the sputum can not be discharged, and there is a secondary urination. Some patients have hematuria due to infection and stones in the sputum. A small number of patients may have urinary retention due to the huge diverticulum located in the bladder neck and compressing the bladder outlet, which may cause constipation and oppress the uterus and cause dystocia.

Generally no special symptoms, such as combined with obstruction, infection, dysuria, frequent urination, urgency, dysuria, and some hematuria. In the huge diverticulum, there may be two symptoms of urination, which is a characteristic manifestation of this disease. Combined with imaging examination and endoscopy, the diagnosis can be confirmed.

Differential diagnosis

1. Ureteral diverticulum: When there is a concurrent infection, there are also urinary tract irritation such as frequent urination, urgency, and dysuria. When the diverticulum is large, the sacral mass may also be blocked, but B-ultrasound shows that the cystic mass is outside the outline of the bladder. The diverticulum at the lower end of the ureter can be combined with excretory or retrograde urography with B-ultrasound, CT, MRI, showing the location of the diverticulum, and the ureteral dilatation can be seen above the diverticulum.

2. Urethral diverticulum: There are also two urinations, but cystography and urinary bladder urethrography can show that there is no diverticulum in the bladder, cystic mass in the urethra, urethroscopic examination shows that the diverticulum is in the urethra rather than in the bladder.

3. Prostatic hyperplasia can also have segmental urination, some patients may have pseudo-diverticulum, but the patient is older, the symptoms are mainly urinary frequency, urgency, especially at night. The rectal examination showed that the prostate volume increased and the central groove became shallow. B-ultrasound and CT showed prostate enlargement and bulging, and the patient's urine flow rate was abnormal.

4. Repeated bladder: B-ultrasound and CT examination showed that the bladder has intact muscle layer and mucous membrane. There is separation in the bladder or two intact bladders by urethrography and cystoscopy.

If there is no complication, there is no special symptoms in the bladder diverticulum. If there is obstruction or infection, symptoms such as dysuria, frequent urination, urgency, and urinary tract infection may occur. Some diverticulum can be as large as 2000ml, which compresses the bladder neck and urethra, leading to lower urinary tract obstruction. There is no muscle contraction in the diverticulum, which leads to poor drainage of the urine. It is easy to be accompanied by ureteral bladder reflux. One or both sides of the hydronephrosis may occur, eventually leading to renal failure. But there are also congenital giant diverticulum without urinary tract obstruction. Due to the small amount of muscle fibers in the bladder diverticulum, during the urination, the urine in the sputum can not be discharged, and there is a secondary urination. Some patients have hematuria due to infection and stones in the sputum. A small number of patients may have urinary retention due to the huge diverticulum located in the bladder neck and compressing the bladder outlet, which may cause constipation and oppress the uterus and cause dystocia.

Generally no special symptoms, such as combined with obstruction, infection, dysuria, frequent urination, urgency, dysuria, and some hematuria. In the huge diverticulum, there may be two symptoms of urination, which is a characteristic manifestation of this disease. Combined with imaging examination and endoscopy, the diagnosis can be confirmed.

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