Bladder diverticulum: causes, symptoms, treatment, prevention

What is a bladder diverticulum?

Bladder diverticulum is a pouch, a pocket that protrudes from the wall of the bladder (urea). There are two types of bladder diverticulum: congenital and acquired. Congenital means the person was born with this sac; acquired means the bag has formed due to a health condition that has affected the bladder. Patients diagnosed with this condition may have more than one formed sac.

Congenital diverticula are usually diagnosed during childhood or by prenatal ultrasound (ultrasound). Acquired bladder diverticula are often caused by blockage of urea due to increased prostate, urethral stricture (narrowing of the urethral lumen) or neurological diseases. They are often discovered by chance during imaging studies due to other medical conditions.

Signs and symptoms

Bladder diverticula are often asymptomatic and are occasionally found in other conditions investigations. If the disease is symptomatic, symptoms depend on the underlying cause, the size of the diverticulum, its location, and the size of the collar. Some of the symptoms include two-stage urination (typical of larger diverticula), urinary retention,

urinary tract infection, blood in urine, vesicoureteral reflux.

Bulky, broad-necked diverticula tend to absorb the work of the bladder muscles, followed by significant urinary stasis and subsequent urinary tract infections. Narrow-necked diverticula can cause recurrent infections as well as intra-articular stones and mucosal metaplasias.

Causes and risk factors

Congenital diverticulum forms when part of the lining of the bladder penetrates the weak part of the bladder wall (congenital weakness of the bladder wall), creating a kind of "Bag". This almost always happens on its own and does not require treatment.

Acquired diverticula are often more than one and are usually secondary to bladder neck obstruction; obstruction, in turn, is caused by benign prostatic hyperplasia, urethral stricture, or bladder neck sclerosis. This obstruction causes an increase in pressure within the organ, which can lead to the possible formation of a diverticulum, usually at the weakest points of the urea.

The diverticulum may also be secondary to previous bladder surgeries or to neurogenic changes in bladder emptying.

Diagnostics

Bladder diverticula may be suspected when a patient has symptoms such as recurrent urinary tract infections, chronic pelvic pain syndrome with signs of inflammation, a feeling of fullness in the abdomen, incomplete emptying of the bladder, or problems in general emptying that suggest obstruction and stasis (congestion) urine. However, patients may not have specific symptoms, and diverticula may be detected when investigated for other problems. An excellent means of detecting bladder diverticula is a cystogram, which allows to obtain an X-ray image of the bladder using cystography, by introducing a contrast dye.

A diverticulum can also be found with cystoscopy, which is especially important for checking for tumors in the diverticulum by inserting a flexible cystoscope through the urethra into the bladder. Bladder function and the presence of bladder neck obstruction can be assessed with a bladder pressure test (urodynamic test). Finally, in some cases it may be necessary to check the effect of the obstruction on the kidneys by performing an ultrasound examination of the kidneys.

Treatment

Congenital or acquired bladder diverticula do not always require treatment, especially if they are not associated with urinary infections pathways, bladder stones or vesicoureteral reflux (backflow of urine from the bladder into the ureter, into the renal pelvis). Instead, treatment is needed for a bladder diverticulum associated with bladder tumors, recurrent infections, and urinary retention.

Treatment is also necessary in the event of a spontaneous rupture of a diverticulum and, in general, in the presence of symptoms. For patients with diverticulum and urinary tract obstruction, treatment includes resolution of the obstruction and (possible) removal of the diverticulum. The diverticulum can be removed surgically, either openly or laparoscopically (using small incisions and openings for instruments and a camera).

Prophylaxis

Specific preventive measures have not been developed. In the presence of inflammatory diseases of the bladder, it is necessary to seek medical help as soon as possible. Often, the disease is detected during additional studies associated with the diagnosis of other diseases. For prevention, early diagnosis of conditions such as prostate adenoma, stricture is very important urethra, urethral sclerosis and other disorders that prevent outflow urine.