Diverticulum of urinary bladder

The causes which raise the intravesical pressure leads to hypertrophy of the urinary bladder. Later protrusion of mucosa in the muscles will leads to multiple saccules formation, one (or more) of them may be force to protrude out completely to form diverticulum.

Congenital diverticulum are developmental defect like un-obliterated vesical end of the urachus are situated in midline anterosuperiorly, rottenly no treatment is required.

Acquired diverticulum are due to bladder outflow obstruction (BPH), their mouth is usually situated above and outer side of ureteric orifice. Diverticulum vary in size and some times are quite big. Their wall is formed of fibrous tissue without muscles in it and are lined by bladder mucosa.

Traction diverticulum or herniation of bladder in inguinal hernia are seen and got treated by hernial operation.

Complications which leads to their diagnosis are:-

Recurrent urinary infection due to incomplete emptying of diverticulum (lack of muscles in its wall) leads to stasis of urine.

Bladder stone formation, due to stasis and infection.

Squamous cell metaplasia, leukoplakia, carcinoma, etc. may be seen in the diverticulum.

Clinical features are old males with out let obstruction and repeated infection or rarely hematuria (infection, stones, carcinoma). Some may have twice micturition in one sitting.

Diagnosis is incidentally by ultrasound.

Operation is indicated only after dealing with outlet obstruction (prostatectomy) and when complications of diverticulum are stressing. Open diverticulectomy is recommended. Open the urinary bladder, safe the ureter by placing ureteric stent in it, separate the diverticulum from surroundings, excised the diverticulum with its neck, repair urinary defect in one or two layers, repair the urinary bladder after putting three ways follies catheter in it, place a pelvic drain and close the abdomen in layers.

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