Indian Journal of Urology
CASE REPORT
Year
: 2002  |  Volume : 18  |  Issue : 2  |  Page : 169--170

Congenital bladder diverticulum - a rare cause of bladder outlet obstruction in children


Anjali A Bokil, Hemendra N Shah, Percy Jal Chibber 
 Department of Urology, Sir JJ Hospital, Mumbai, India

Correspondence Address:
Percy Jal Chibber
Department of Urology, Sir JJ Hospital, Byculla, Mumbai - 400 008
India




How to cite this article:
Bokil AA, Shah HN, Chibber PJ. Congenital bladder diverticulum - a rare cause of bladder outlet obstruction in children.Indian J Urol 2002;18:169-170


How to cite this URL:
Bokil AA, Shah HN, Chibber PJ. Congenital bladder diverticulum - a rare cause of bladder outlet obstruction in children. Indian J Urol [serial online] 2002 [cited 2022 May 24 ];18:169-170
Available from: https://www.indianjurol.com/text.asp?2002/18/2/169/37631


Full Text

 Case Report



A 7-month-old male child presented with episodic ob­structive voiding symptoms since 4 months and history of recurrent episodes of retention of urine. On examination he had palpable bladder for which infant feeding tube was inserted per-urethra. His serum creatinine was normal. On ultrasound he had moderate left hydronephrosis with en­tire length hydrorureter ending into a cystic structure sepa­rate from bladder. Intravenous urography showed left gross hydronephrosis and hydroureter with a huge bladder di­verticulum. Micturating cysto-urethrogram showed evi­dence of bladder diverticulum with no reflux and no lower urinary tract obstruction. Cystoscopy failed to identify bladder diverticulum clearly. Magnetic resonance urogram was done, which confirmed left-sided bladder diverticu­lum with infant feeding tube coiled in it ruling out of pos­sibility of an ureterocele [Figure 1]. On exploration he had left-sided congenital bladder diverticulum with left ureter opening into it. The lower part of diverticulum extended inferiorly by the side of and displacing the bladder neck and urethra [Figure 2]. This was responsible for episodic re­tention. Divert) culectomy with left ureteric re-implanta­tion was done. Patient was asymptomatic post-operatively.

 Comments



Congenital bladder diverticulum is uncommon. It is fre­quently located on the trigonal margin in close proximity to the ureteral hiatus, which may progressively become incorporated into the diverticulum. It may cause vesicoure­teral reflux, recurrent urinary tract infection, stone forma­tion and incontinence. A low-lying diverticulum may rarely attain large size sufficient to compress bladder neck and posterior urethra. Resultant obstruction further diverts urine into the diverticulum, leading to a self-perpetuating cycle. Sheldon and Essing, who described a similar case in 1994, reviewed the literature and noted only 10 such cases reported previously. Although asymptomatic diver ticulum may be ignored, those causing complications should be treated surgically with diverticulectomy. Since the diverticulum is usually adherent to adjacent structures, such as the rectum, ureter and vas deferens, careful extravesical dissection is imperative during excision. The muscular defect in the bladder should be meticulously re­paired and the ipsilateral ureter almost always requires reimplantation.[3]

References

1Sheldon CA, Essing KA. Congenital bladder diverticulum causing bladder outlet obstruction : case report and review of literature. Ped Surg Int 1994: 9: 141.
2Vergese M, Belman AB. Urinary retention secondary to congenital bladder diverticula in infants. J Urol 1984; 132: 1186.
3Zia-Ul-Miraj M. Congenital bladder diverticulum : A rare cause of bladder outlet obstruction in children. J Urol 1999; 162: 2112-2113.