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CASE REPORT |
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| Year : 2002 | Volume
: 19
| Issue : 1 | Page : 84-86 |
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Bladder outlet obstruction due to congenital bladder diverticulum: Case report and review of literature
P Sadashiva Rao, Vijay Kumar, PLNG Rao
Department of Pediatric Surgery, K.M.C., Manipal and K.M.C., Mangalore, India
Correspondence Address:
Vijay Kumar
Department of Pediatric Surgery, KMC, Manipal - 576 119
India
 Source of Support: None, Conflict of Interest: None  | Check |
 Abstract | | |
Acute urinary retention in infancy, due to a congenital bladder diverticulum (CBD) is rare. The literature is scanty on the subject. We report 2 such cases. In both of them the ureters were opening directly into the dive rticulitin. One of them had a complete duplex system on the left side, which is the first reported of its kind, with both ureters of the duplex system opening into the diverticulum.
Keywords: Bladder Diverticulum; Bladder Outlet Obstruc-tion; Duplex System
How to cite this article:
Sadashiva Rao P, Kumar V, Rao P. Bladder outlet obstruction due to congenital bladder diverticulum: Case report and review of literature. Indian J Urol 2002;19:84-6 |
How to cite this URL:
Sadashiva Rao P, Kumar V, Rao P. Bladder outlet obstruction due to congenital bladder diverticulum: Case report and review of literature. Indian J Urol [serial online] 2002 [cited 2020 Nov 24];19:84-6. Available from: https://www.indianjurol.com/text.asp?2002/19/1/84/20301 |
| Introduction | |  |
Congenital bladder diverticulum (CBD), almost always seen in boys. rarely leads to complications. It has got varied presentations like bladder outlet obstruction, ureteral obstruction, urinary tract infection. incontinence, etc. [1],[2] It can be associated with other urological problems like duplex system. [3]
| Case Reports | | |
Case 1: An 8-month-old male child presented with the history of dysuria, fever of 4 days and urinary retention of one day duration. From the age of 1th months, patient had intermittent episodes of dysuria with fever. At admission, the acute retention was relieved by catheterization and draining 300 ml of urine (expected bladder capacity-70ml). Abdominal ultrasound and micturating cystourethrogram showed a large diverticulum arising from the posterolateral wall of the bladder on the left side and descending down to obstruct the bladder neck.
No vesicoureteric reflux was detected. Intravenous urogram showed normal right ureter and medially displaced left ureter. Cystoscopy showed diverticulum opening at the left corner of the trigone. Right ureteric orifice was normal but left ureteric orifice was not seen. On exploration, the diverticulum was seen to arise from the left side of the bladder wall extending posterocaudally. Duplex system was seen on the left side with stenotic upper moiety orifice opening on the lip of the diverticulum and lower moiety orifice of normal size opening proximally on the medial wall of the diverticulum. The diverticulum was excised by combined intra- and extravesical approach and Politano Leadbetter's reimplantation of ureters in single sheath was carried out. Child is healthy with a follow-up of more than 4 years.
Case 2 : A 3-month-old male child presented with acute retention of urine of 2 days duration for which he was catheterized. Child had a similar episode 2 weeks prior to admission with dysuria. Urine analysis showed 20-25 WBCs/HPF and the culture was sterile. Abdominal ultrasound detected a diverticulum arising from the posterolateral wall of the bladder on left side, enlarging caudally, to compress the bladder neck. Micturating cystourethrogram confirmed the sonology findings and did not show any vesicoureteric reflux. Intravenous pyelogram showed minimally functioning left kidney. On cytoscopy, mild trebaculation and the diverticular opening on the left corner of the trigone was visualized whereas the left ureteric orifice could not be made out. The right ureteric orifice was normal. The diverticulum was excised by both intra- and extravesical approach and Politano Leadbetter's reimplantation of left ureter was done. The child is healthy with a follow-up of 3 years.
| Comments | | |
Congenital bladder diverticulum (CBD) rarely leads to complications and presenting with an outlet obstruction is unusual. CBD almost always occurs in males and are usually solitary [4],[5] and they commonly present with urinary tract infection. [2],[5] Congenital weakness of the musculature near the ureteric orifice is a universally accepted cause for these diverticula. Bauer et al proposed that trigone and the rest of the bladder have different embryological origin. which results in the weakness at the point of continuity (i.e., at ureteric orifices). [6] Johnson et al describes that the diverticula occur due to muscular deficiency at the ureteric insertion into the trigone. [7] As the diverticulum enlarges the ureteric orifice gets incorporated into it. [4],[7] These diverticula may obstruct the outlet or ureter and may lead to recurrent urinary tract infection, reflux, stone formation, urinary incontinence, etc. [1],[2] During the detrustor contraction, as the diverticulum fills, the urethra gets obstructed and more urine flows into the diverticulum further pressing the posterior urethra. [9] Urethral obstruction due to a CBD was described first by Schiff and Lytton in 1970 and majority of them presented in infancy. [1],[9] Micturating cystourethrogram in both oblique views and cystoscopy are the best tools for diagnosing this condition. The distorted anatomy due to large diverticulum, failure of diverticulo-ureteric reflux and the poor function of the affected kidney/moiety of the duplex kidney all contributed to the difficulties in establishing the complete anatomical configuration ; in our first case. Even though ureteric orifice is in its abnormal position, reflux was not seen in more than 50% of the reported cases, especially when the diverticulum was unilateral with outlet obstruction. Though different approaches have been described for bladder diverticulectomy, combined intra and extravesical approach was found to be more convenient. [10]
| Conclusions | | |
Congenital diverticulum though rare should be considered as a possibility in infants with lower urinary tract obstruction. Its association with a duplex system is even rarer and ours appears to be the first to be reported in English literature. Surgical excision of the diverticulum with reimplantation of the ureter results in complete cure and the prognosis appears to be good.
| References | | |
| 1. | Sheldon CA. Essig KA. Congenital bladder diverticulum causing bladder outlet obstruction: Case report and review of literature. Pediatr Su g Int. 1994; 9: 141.  |
| 2. | Pieretti RV, Pieretti RV-Vanmarcke. Congenital bladder diverticula in children. J Pediatr Surg 1999; 34(3): 468. |
| 3. | Beasley SW, Kelly JH. Inverted Y duplication of the ureter in association with ureterocele and bladder diverticulum. J Urol 1986; 136(4): 899. |
| 4. | Gearhart JP, Jeffs RD. Exstrophy epispadias complex and bladder anomalies. In Campbell's Urology, 7 th edition. Walsh PC, Retik AB, Vaughan ED Jr and Wein A J (eds). Philadelphia, WB Saunders company, 1998:2: 1939-90. |
| 5. | Lione PM and Gonzales ET Jr. Congenital bladder diverticula causing ureteral obstruction. Urol 1985; 25(3): 273. |
| 6. | Bauer SB and Retik AB. Bladder diverticula in infants and children. Urol 1974: 3(6): 712. |
| 7. | Johnson JH. Bladder disorders. In Pediatric Urology: William DI, Johnston JH (eds.). London, Butterworth Scientific. 1982; 225-237. |
| 8. | Taylor WN, Alton D, Togu i A, Churchill BM, Schillinger JF. Bladder diverticula causing posterior urethral obstruction in children. J Urol 1979: 122(3): 415. |
| 9. | Parrott TS, Bastuba M. Giant bladder diverticulum causing urethral obstruction in an infant. Br J Urol 1992: 69(5): 545. |
| 10. | Verghese M, Belman AB. Urinary retention secondary to congenital bladder diverticula in infants. J Urol 1984: 132(6): 1186. |
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