What Is Bladder Diverticulitis?

The diverticulum of bladder is a sac that bulges out of the bladder mucosa through the muscle layer of the bladder wall. It is divided into congenital and secondary (acquired). The congenital bladder diverticulum wall contains muscle fibers. Urinary tract obstruction. If there are no complications and no special symptoms of the bladder diverticulum, such as obstruction, urinary retention, infection, stones, rupture, and diverticulum cancer, symptoms of dysuria, lower abdominal pain, hematuria, frequent urination, urgency, and urinary tract infection may occur. Treatment is mainly to relieve lower urinary tract obstruction and control infection.

Basic Information

English name: bladder dlerticulum
Visiting department: Urology
Common locations: bladder
Common causes: Urethral stricture, posterior urethral valve, bladder neck contracture, obstruction; lower urinary tract obstruction and bladder hypertension

Common symptoms: If there are obstructions and infections, it may be difficult to urinate, frequent urination, urgency, urinary tract infections, etc .; some diverticulum compress the bladder neck and urethra, resulting in lower urinary tract obstruction

Causes of bladder diverticulum

Due to the defect of the bladder muscle layer, the local formation of the bladder bulges outward, which occurs in the posterior part of the bladder side, often accompanied by the formation of bladder trabeculae and atrium.

Congenital lesion

Such as urethral stricture, posterior urethral valve, bladder neck contracture, obstruction promote the formation and development of diverticulum, are the main factors of diverticulum.

2. Acquired Lesions

Lower urinary tract obstruction and bladder hypertension (neurogenic bladder) are the main causes of secondary bladder diverticulum formation.

Clinical manifestations of bladder diverticulum

If there are no complications and no special symptoms of the bladder diverticulum, if there is obstruction or infection, symptoms such as dysuria, frequent urination, urgency, and urinary tract infection may occur. Some diverticulum can compress the bladder neck and urethra, resulting in lower urinary tract obstruction. Diastolic no muscle contractility can lead to poor drainage of urine, easy to be accompanied by ureteral bladder reflux, hydronephrosis on one or both sides can occur, and eventually lead to renal failure. There are also patients with congenital huge diverticula without urinary tract obstruction. Because there are few muscle fibers in the bladder diverticulum, urine cannot be discharged from the huge diverticulum during urination, and secondary urination symptoms may occur. Some patients have hematuria due to infection stones in the diverticulum. A small number of patients may have urinary retention due to the huge diverticulum located behind the bladder neck and compressing the bladder outlet. Compression of the rectum may cause constipation and oppression of the uterus, resulting in dystocia.

Bladder diverticulum examination

Urine routine

There may be red blood cells and pus cells in the urine when complicated with infection stones.

2. Imaging examination

Intravenous urography can show compression or displacement of diverticulum or ureter, but the most effective method is oblique or lateral micturition of urinary bladder urethra. Re-imaging after bladder emptying can help further confirm the diagnosis. B-mode ultrasonography after bladder filling and urination can also help diagnosis. Cystoscopy / soft cystoscopy can see the relationship between the opening of the diverticulum and the opening of the ureter, and can be extended into the diverticulum to understand the presence of stones and tumors. CT virtual cystoscopy / MRI can be used as an alternative method for non-invasive examination when the bladder is full.

Bladder diverticulosis diagnosis

Diagnosis based on clinical manifestations and examinations.

Differential diagnosis of bladder diverticulum

Ureteric diverticulum

Complicated infections also have symptoms of urinary tract irritation such as frequent urination, urgency, and dysuria. Masses can also be affected when the diverticulum is large, but B-mode ultrasound shows that the cystic mass is outside the outline of the bladder. Diverticula at the lower end of the ureter can be obtained by B-ultrasound, CT, MRI combined with excretory or retrograde urography, showing the location of the diverticulum, and ureteral dilatation can be seen above the diverticulum.

2. Urethral diverticulum

There are also two segments of urination, but cystography and urination cystourethrography can show no diverticulum in the bladder, cystic mass in the urethra, and urethroscopy revealed that the diverticulum opens in the urethra and not in the bladder.

3. Prostatic hyperplasia

There may also be segmented urination, and some patients may have pseudo diverticulum, but the patients are older and the symptoms are mainly frequent urination and urgency, especially at night. Digital rectal examination of the prostate volume increased, central groove became shallower, B ultrasound, CT can show prostate enlargement, bulge, patients with abnormal urine flow rate.

4. Repeat the bladder

Large bladder diverticula need to be distinguished from repeated bladder. Ultrasonography and CT showed that the bladder had complete muscle layers and mucous membranes. Transurethral angiography and cystoscopy showed that there were separate or two complete bladder in the bladder.

Bladder diverticulum complications

Diverticula are mostly located at the bottom and sides of the bladder, and the walls are weak. They can be infiltrated with inflammatory cells, and can be complicated by stones and tumors. The enlarged diverticulum can also compress the ureter to cause displacement and obstruction. If the obstruction develops further, the glomerular filtration rate can be reduced due to the increase in intravesical pressure, urine output can be reduced, and creatinine and urea nitrogen can be blocked. In severe cases, renal insufficiency or renal failure can occur. Bladder diverticulum rupture is currently not widely reported, and its symptoms are consistent with bladder rupture. Bladder diverticulum urothelial cell carcinoma is also rare, mainly manifested as painless gross hematuria.

Bladder diverticulum treatment

Conservative treatment is mainly to relieve lower urinary tract obstruction and control infection. At present, it is preferred to perform diverticulectomy and diverticulum electrocautery first through the urethra to drain diverticulum urine, especially for elderly patients with more concurrent diseases, patients with a previous history of abdominal surgery or radiotherapy, and Coagulation patients. If the effect is not good, consider open or laparoscopic / robot-assisted laparoscopic diverticulectomy. If the diverticulum is huge and the ureteral orifice is close to or opening in the diverticulum, a diverticulum resection must be performed, and a regurgitation of the ureteric bladder must be performed to prevent reflux. Attention should be paid to repairing the bladder muscle defect at the ureteral orifice.