Diverticulum of the Bladder A Method of Roentgen Examination and the Roentgen and Clinical Findings in 200 Cases

Abstract

It is the purpose of this report to outline a method of roentgen examination for diverticulum of the bladder and to give a brief summary of the roentgen and clinical findings in 200 cases. Diverticulum of the bladder is a frequent and serious complication of bladder neck obstruction. Its incidence in 1,600 cases of benign hypertrophy of the prostate and carcinoma of the prostate was 9 per cent. The presence of this complication more than doubled the mortality rate of operation for relief of the bladder neck obstruction, increased the morbidity rate, and in many cases necessitated accessory operations upon the diverticulum itself before an adequately functioning bladder was obtained. Because of the frequency and seriousness of diverticulum in association with bladder neck obstruction, demonstration of the presence or absence of this complication and, if it is present, the facts with regard to it are of importance. The clinical significance of any given diverticulum depends on its size, its position, the size of its neck, its contents, whether or not it empties spontaneously, and the condition of the bladder. The presence or absence of bladder neck obstruction or obstruction to the upper urinary tract and the nature and extensiveness of these changes are also of importance. These facts with regard to the individual case can be ascertained only by a complete examination—physical, cystoscopic, and x-ray. The most important single examination, however, is the radiographic. Without this, many cases are not recognized and most of the desired information with regard to the diverticulum cannot be determined. The routine roentgen examination consists essentially of three parts: (1) examination of the bladder neck and urethra; (2) upper urinary tract examination, which includes the kidneys and ureters; (3) examination of the bladder and diverticulum. The method used to ascertain the presence or absence of prostatic and/or urethral obstruction is the cystourethrographic study which was developed by one of us (R. F.). This consists essentially of four films: (1) the flat film; (2) the opaque anteroposterior cystogram; (3) the air cystogram taken in the oblique position; (4) the cystourethrogram. A great deal of information with regard to the bladder and urethra is obtained by this examination. The flat film shows the presence or absence of metastatic lesions in the bones and of opaque urinary calculi. The sodium iodide cystogram shows the presence or absence of diverticula, ureteral reflux, displacement of the bladder, irregularity of the bladder wall, and filling defects due to tumors or prostatic enlargement. The air cystogram shows the presence or absence of non-opaque vesical stones, enlargement of the prostate, and vesical cancer. The cystourethrogram gives more information with regard to the nature of the prostatic enlargement and at the same time shows the presence or absence of urethral stricture or any other pathologic urethral process.