|Year : 2003 | Volume
| Issue : 1 | Page : 65-67
Congenital bladder diverticulum: Report of three cases
Sajni Khemchandani, Prakash Ranka
Department of Pediatric Urology, Institute of Kidney Diseases and Research Centre and Institute of Transplantation Sciences, BJ Medical College and Civil Hospital Campus, Ahmedabad, India
401, Sudarshan Flats, 13 Shantinagar Society, Usmanpura, Ahmedabad - 380 013
Source of Support: None, Conflict of Interest: None
Keywords: Bladder. diverticulum. congential, bladder outlet obstruction.
|How to cite this article:|
Khemchandani S, Ranka P. Congenital bladder diverticulum: Report of three cases. Indian J Urol 2003;20:65-7
A 30-day-old male child presented with retention of urine. On examination, bladder was palpable and he was catheterized. His serum creatinine was 1.27mg%. Ultrasonography (USG) showed left hydroureteronephrosis (HUN). Voiding cystourethrogram (VCUG) showed grade V left vesico-ureteric reflux (VUR), with the dilated, tortuous ureter opening in a diverticulum and obstructing the posterior urethra [Figure - 1]. DTPA renal scan showed 33% differential function of the left kidney. Vesicostomy was done; serum creatinine decreased to 0.45mg%. At 6 months of age, intravesical diverticulectomy with left ureteric tapering and reimplantation was done by Politano Leadbetter technique. Six months postoperatively, the child was asymptomatic with normal USG.
A 5-month-old male child presented with history of obstructive voiding symptoms and retention of urine. On examination, the bladder was palpable for which he was catheterized. His serum creatinine was normal. USG showed bilateral mild HUN with 2 large diverticula posterior to the bladder. VCUG showed 2 large bladder diverticula pressing the urethra with no reflux. Intravenous pyelography (IVP) showed bilateral normal excretion of contrast. On cystoscopy, the necks of both the diverticula were visualized, although the ureteric orifices were not seen. Bilateral intravesical diverticulectomy with Cohen's cross-trigonal ureteric reimplantation was done [Figure - 2]. The child was asymptomatic postoperatively, with normal USG at 1 year.
A 1-year-old male child presented with history of recurrent episodes of retention of urine. On examination, the bladder was palpable and he was catheterized. Serum creatinine was normal. USG showed mild left HUN with a huge cystic structure posterior to the urinary bladder. VCUG showed a large bladder diverticulum with grade V -VUR. IVP showed bilaternal prompt excretion of contrast with left mild hydronephrosis and a large bladder diverticulum. On cystoscopy, the neck of the bladder diverticulum was well visualized although the ureteric orifices could not be made out. Diverticulum was excised by intravesical inversion technique and left ureteric Kalcinski infolding and reimplantation was done. The child was asymptomatic postoperatively, with normal USG and VCUG at 9 months.
| Comments|| |
Congenital bladder diverticulum (CBD), presenting with outlet obstruction is very uncommon. It is frequently located on the trigonal margin in close proximity to the ureteral hiatus, which may progressively become incorporated in the diverticulum. It may cause VUR, recurrent urinary tract infection, stone formation and urinary incontinence. A low-lying diverticulum rarely attains a large size sufficient to compress the bladder neck and posterior urethra leading to outlet obstruction.  Bokil et al (2002)  reported a case of congenital bladder diverticulum which could not be identified on cystoscopy. They performed magnetic resonance urogram to confirm the CBD and to rule out ureterocele. However, in the present series we would identify bladder diverticulum clearly in all the 3 cases as they were open and wide mouth. We prefer vesicostomy as a temporizing measure in neonates with raised serum creatinine followed by definitive surgery at a later date. Diverticulectomy may be performed by an extravesical, intravesical or combined approach. For the intravesical inversion technique to be applied, the diverticulum must have an open mouth.  Our experience is that the intravesical diverticulectomy is a simple technique that is easy to perform. It facilitates ipsilateral cannulation of the ureter and thus it obviates ureteral injury, which is a potential complication with extravesical dissection.
| References|| |
|1.||Zia-Ul-Miraj M. Congenital bladder diverticulum: A rare cause of bladder outlet obstruction in children. J Urol 1999: 162: 2112-2113. |
|2.||Bokil AA, Shah H N and Chibber PJ. Congenital bladder diverticulum-A rare cause of bladder outlet obstruction. Ind J Urol 2002:18: 169-170. |
|3.||Hinman F. Jr : Excision of vesical diverticulum. In : Hinman F Jr (ed.): Atlas of Urologic surgery. 2nd ed. Philadelphia, W.B. Saunders company, 1994, pp. 538-539. |
[Figure - 1], [Figure - 2]