Congenital Bladder Diverticula Research Articles

Lower Urinary Tract Symptoms Produced by a Large Congenital Urinary Bladder Diverticulum: Surgical Decision Challenged?

Abstract Urinary bladder diverticula represent herniation of the urothelium through muscularis propria of the urinary bladder wall. Bladder diverticula do not contain a defined functional muscularis propria layer and therefore empty poorly with micturition. In the adult, bladder diverticula are often associated with bladder outlet obstruction or neurogenic vesicourethral dysfunction. Congenital bladder diverticula are usually solitary, associated with a smooth-walled bladder, and occur in the absence of bladder outlet obstruction. Bladder diverticula are most often diagnosed incidentally during the evaluation of nonspecific lower urinary tract symptoms or infection. We present the case report of a very large congenital diverticulum of the urinary bladder (probably aggravated by bladder outlet obstruction), presented in a 75-year-old man with symptoms of urinary obstruction, leading to chronic retention, frequency, and recurrent urinary tract infections.

Radiological diagnosis and management of congenital bladder diverticulum in pediatric patients.

Radiological diagnosis and management of congenital bladder diverticulum in pediatric patients.

Robot-assisted bladder diverticulum removal in a 10-year-old child

BACKGROUND: Bladder diverticulum are hernias of the bladder mucosa that prolapse through a detrusor defect. Diverticulectomy is the treatment of choice for this disease. Surgical methods to implement this principle include open, laparoscopic and robotic approaches. In the present study, we outline our own technique for performing robotic diverticulectomy and report its short-term results.
 CLINICAL CASE DESCRIPTION: The study reports one case of bladder diverticulectomy performed with a robot-assisted technique in a 10-year-old boy. The diagnosis of the disease was established using voiding cystourethrography, cystoscopy and X-ray computed urography. The patient had robot-assisted bladder diverticulectomy using transperitoneal extravesical access. At the final stage of the study, short-term outcomes of the robot-assisted procedure were evaluated. The duration of the operation was 100 minutes. No intraoperative and postoperative complications were observed. The urinary catheter was removed the day after the operation. The duration of the patient's stay in the hospital was 7 days. Histological examination showed signs corresponding to a false diverticulum of the bladder with the presence of single muscle fibers in its structure. The ureteral stent was removed one month after the operation. After removal of the stent, control voiding cystography was performed, which demonstrated the absence of bladder contour deformation at the site of surgical procedure.
 CONCLUSION: Robot-assisted bladder diverticulectomy is a technically feasible approach to the treatment of congenital bladder diverticulum.

Endovideosurgical interventions in the bladder diverticulum in children

Introduction. Among congenital and acquired malformations in the urinary system organs, one of the topical issues is the choice of management modalities in bladder diverticulum. Modern equipment and development of minimally invasive techniques have expanded the variability of curative approaches, which is especially important for children with comorbidities.Purpose. To optimize surgical treatment of children with bladder diverticulum using minimally invasive surgical interventions, to reduce the rate of intraoperative and postoperative complications as well as to improve endovideosurgical access for the successful implementation of reconstructive interventions based on the authors' analysis of their own material on treating children with bladder diverticula.Material and methods. Five patients of different age having a bladder diverticulum with various anatomical features and with comorbidities were treated at the surgical department of St. Luka Clinical Research Specialized Center for Children (Moscow, Russia) in 2021–2022. The researchers could find the principle for selecting a proper surgical modality after they had assessed positive and negative aspects of each type of surgical access.Results. While choosing the type of surgical access in the discussed patients, the authors took into account anatomical features, concomitant pathologies, findings of instrumental diagnostics. As a result, all patients had good outcomes. The authors demonstrated a successful application of endovideosurgical techniques in the management of patients with congenital bladder diverticula after they had analyzed their own clinical material. They also described effective techniques for reconstructing ureterovesical anastomosis area with consideration of its place in relation to the diverticulum.Conclusion. The pneumovesicoscopic access for congenital bladder diverticulum removal is the most rational one, as it allows to accurately restore the relationship of anatomical structures.

Large congenital bladder diverticula in children.

Large congenital bladder diverticula (LCBD), congenital bladder diverticula (CBD) larger than 2 cm diameter, is a rare anomaly. The aim of this study was to report long-term surgical and clinical outcomes of children with LCBD. Medical charts of all children who were diagnosed with LCBD at our institution between April 2005 and December 2017, with at least 2 year follow-up were retrospectively reviewed. Patients' demographics, symptoms, operative technique, diverticulum size and localization, surgical outcomes and complications were recorded. Fourteen patients with 18 LCBD, all male and age between 7 and 240 months (mean age: 53.5 months) were included in the study. Urinary tract infection was the main complaint in 10. Vesicoureteral reflux was detected in eight patients. Diverticula were 2-5.5 cm (mean 3.3 cm) in size. All diverticulectomies were performed transvesically and ureteroneocystostomy was added in 12 patients, 5 of whom were bilateral. No postoperative infection or recurrent reflux were observed. The median follow-up period was 4.5 years (2-12 years). Treatment of LCBD is mostly surgical and transvesical approach for diverticulectomy was found to be a safe and effective surgical procedure in long term follow-up.

Robot-assisted laparoscopic diverticulectomy with ureteral reimplantation

The objective is to describe our experience with robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation in a pediatric patient. A 7-year-old male presented with a symptomatic urinary tract infection secondary to Staphylococcus epidermidis. The patient was found to have a large congenital paraureteral bladder diverticulum on work-up. His options were discussed and he proceeded with robotic diverticulectomy. Intraoperatively, the diverticulum was found to obscure the left ureteral orifice, which necessitated synchronous dismembered extravesical ureteral reimplantation. Robot-assisted laparoscopic diverticulectomy with extravesical ureteral reimplantation was performed. The procedure time was 283min, and estimated blood loss was 3mL. The patient was discharged home on post-operative day 1. He was last seen in clinic six months after surgery and was doing well without any recurrent urinary tract infections. This video demonstrates a robotic approach for the treatment of complex congenital bladder diverticula. Robotic surgery offers the benefits of good visualization in the pelvis, minimal blood loss, and quick convalescence. Key portions of the diverticulectomy and ureteral reimplantation are clearly illustrated in this video, which can help other surgeons adopt this technique.

A case of giant congenital bladder diverticulum in a second trimester fetus

А case of giant congenital bladder diverticulum in a second trimester fetus is presented. On the ultrasonography at 16 weeks of gestation extremely enlarged anechoic pelvic mass compressing bladder was detected. Autopsy subsequent to the termination of pregnancy revealed giant bladder diverticulum. Several other abnormalities were also noted: cleft palate and lungs hypoplasia.

A Case of Congenital Bladder Diverticulum in Children With Removal of the Mucous Membrane and Suturing of the Muscular Layer of the CBD

A Case of Congenital Bladder Diverticulum in Children With Removal of the Mucous Membrane and Suturing of the Muscular Layer of the CBD

Rétention aiguë d’urine secondaire à un diverticule congénital bilatéral de la vessie

Bladder diverticula in children are mostly congenital, frequently associated with vesicoureteral reflux. Their positive diagnosis is based primarily on retrograde urethrocystography. One complication of this condition is acute urinary retention. We report the case of a 4-month-old infant who presented acute retention of urine secondary to bilateral congenital bladder diverticulum and review the literature on this subject.

Management of Bladder Diverticula in the Pediatric Population

Bladder diverticula represent protrusion of the urothelial mucosa through the bladder muscular layers and may be either congenital or acquired. Congenital bladder diverticula are usually located adjacent to the ureteral orifices and often are associated with vesicoureteral reflux. Acquired bladder diverticula are usually multiple in nature and are secondary to bladder outlet obstruction or neurogenic bladder. When bladder diverticula are small and do not cause symptoms, non-surgical observation is an acceptable management strategy. The absolute need for surgical intervention of bladder diverticula remains a controversial topic, where current surgical indications for bladder diverticula include diverticula larger than 3 cm, recurrent urinary tract infections, associated severe vesicoureteral reflux, voiding dysfunction, urinary retention, bladder stones, and lower urinary tract symptoms that are persistent after conservative treatment. Open surgical repair has traditionally been the primary treatment choice for bladder diverticula. However, recent advancements in laparoscopic and robotic technology have led to minimally invasive surgical treatment options as alternatives to open surgery with similar success rates, but with reduced morbidity, decreased hospital stay lengths, reduced pain medication requirements, and improved cosmesis.

Bilateral large congenital periureteral bladder diverticula in a child: A case report

Congenital bladder diverticula (CBD) are an outpouching of the mucosa through the muscular wall of the bladder. Large CBD may be presented with a serious urological problem in childhood. A 6-year-old boy was admitted with the complaint of recurrent urinary tract infection and urinary retention. Voiding cystourethrogram revealed a bilateral large CBD. Cystoscopy was performed before surgery to rule out bladder neck pathology, for direct visualization of diverticula, and to see the opening of the ureters. Transvesical diverticulectomy is a reliable technique for surgical treatment, if necessary, and can effectively be combined with the management of associated other pathology.

Vesicoscopic Treatment of Symptomatic Congenital Bladder Diverticula in Children: A 7-Year Experience.

Introduction The objective of this study was to report on the use of vesicoscopy in the treatment of symptomatic congenital bladder diverticula (CBD) in children. Material and Methods In this study, 16 males, aged 4 to 12 years (median age, 6.25 years), were treated for symptomatic CBD; 3 patients presented double diverticulum and 13 presented single diverticulum. The presenting symptoms were recurrent urinary tract infection, hematuria, lower abdominal pain, and voiding dysfunctions as urgency, frequency alone, or in association. A first midline 5-mm trocar was introduced for a 0-degree telescope at the dome of the bladder, and two left and right 3- or 5-mm trocars were inserted through the anterolateral wall. The bladder was then insufflated with carbon dioxide to 10 to 12 mm Hg pressure. The diverticula were inverted into the bladder and the mucosa around the neck was circumcised by using scissors and hook. The defect was sutured and the bladder was drained. Vesicoureteral reflux (VUR) of third grade or higher was treated endoscopically. Results Mean operative time was 90 minutes for procedures. At 6-month follow-up, ultrasound and voiding cystourethrogram (VCUG) showed the disappearance of the diverticulum in 15 out of the 16 patients. The patient, with huge double diverticulum and fourth grade right VUR, presented recurrence of a small left diverticulum. Patients with voiding disorders presented a gradual improvement of their urgency. VUR disappeared at VCUG in all patients. Conclusion Vesicoscopic diverticulectomy resulted a safe and effective procedure and can be considered a valid alternative to the open or laparoscopic procedures. In our opinion, routine use of vesicoscopy could become the gold standard for the treatment of CBD in children.

A rare entity in adults: Bilateral Hutch diverticulum with calculi.

Congenital bladder diverticulum (CBD) is a very uncommon entity in adults. CBD could be unilateral or bilateral and is caused by a congenital weakness in the bladder musculature. CBD is differentiated from the paraureteral or Hutch type of diverticula. A 42-year-old male presented with bilateral Hutch diverticulum and multiple diverticulum calculus on intravenous pyelography. Cystoscopy revealed bladder diverticulum just medial to the left ureteral orifice with multiple calculi; the patient successfully underwent endoscopic laser cystolithotripsy with resolution of his urinary tract infection. To the best of our knowledge, this is the first case report presenting stone formation of CBD in an adult.

Primary congenital bladder diverticula: Where does the ureter drain?

Background:Primary congenital bladder diverticulum (PCBD) is related to a deficient detrusor layer allowing out-pouching of the bladder mucosa through the inadequate muscularis wall. We aimed to review our experience with symptomatic PCBD in order to correlate clinical findings with anatomical aspects and to present late outcome.Materials and Methods:We reviewed all patients operated in our institution since 2004. We evaluated the charts for complaints, radiological exams, method of treatment, complications and length of follow-up.Results:We treated 10 cases (11 renal units - [RU]), predominantly males (9/10), mean age at surgery of 5.3 years. All patients had significant urological complaints presenting either with antenatal hydronephrosis (4) or febrile urinary tract infection (5) and urinary retention in one. The ureter was found implanted inside the diverticulum in 8/11 RU. An extravesical psoas-hitch ureteroneocystostomy and diverticulum resection was performed in 10/11 cases, whereas 1 case was treated intravesically based on surgeon's preference without performing cystoscopy. Mean follow-up was 34.1 months (1-120) without complications.Conclusions:PCBD is an uncommon diagnosis and has a high probability of drainage inside the diverticulum (72.7%). We recommend the extravesical approach associated with diverticulectomy and ureteroneocystostomy as the preferred technique to treat this abnormality.

Vaginal mass caused by a lately recognized congenital bladder diverticulum

Congenital bladder diverticula are strongly associated with vesicoureteral reflux (VUR), and are mostly present in childhood. The most common symptom is urinary tract infection at the time of admission. The diverticulum is usually solitary and its location is near the ureteral orifice, which is probably the main cause of VUR. We report a woman who presented with a vaginal mass located on the right inferior part of the external urethral meatus. The patient had a history of recurrent urinary tract infection and right nephrectomy due to VUR nephropathy. We examined her with cystography, computerized tomography, and cystoscopy. The cystoscopic examination was very diagnostic in our patient. The patient underwent diverticulectomy, and after 6 months of follow-up, her complaints had completely disappeared.

Management of congenital bladder diverticulum in children: A report of seven cases

The purpose of the study is to present the author's experience with congenital bladder diverticula in seven pediatric patients at a developing world tertiary care center. Records of seven patients diagnosed and treated as congenital bladder diverticulum, from January 1998 to December 2009 were retrospectively reviewed for age, sex, clinical symptoms, investigative work-up, operative notes, and postoperative follow-up. All patients were males. Age at presentation ranged from six months to six years (mean three years and six months). All were manifested postnatally by urinary tract infection in four cases, bladder retention in three cases and abdominal pain in two cases. Diagnosis was suggested by ultrasound and confirmed by voiding cystourethrography (VCUG) in all cases and urethrocystoscopy in three cases. Open surgical excision of diverticulum was done in all the patients associated with ureteral reimplantation in four patients with VCUG-documented high-grade vesicoureteral reflux (VUR). Average follow-up was four years; there is a resolution of symptoms and no diverticulum recurrence at the defined mean follow-up. Recurrent urinary tract infections and voiding dysfunction in pediatric population should always be evaluated for congenital bladder diverticulum. Investigations such as abdominal ultrasound, VCUG and nuclear renal scanning, form an important part of preoperative diagnostic work-up and postoperative follow up. Diverticulectomy with ureteral reimplantation in case of high-grade reflux, provides good results without recurrence.

Robot-Assisted Laparoscopic Bladder Diverticulectomy

Robot-assisted laparoscopic bladder diverticulectomy (RALBD) has been increasingly reported in recent years. We review the technique of RALBD and the perioperative outcomes. We searched online databases to identify original articles related to RALBD. In the Method section, we describe our technique and reviewe several techniques for identification and robotic management of bladder diverticula. We identified 13 retrospective studies that met our criteria, with a total of 44 patients. The mean diverticulum size was 8.3 ± 3.6cm, mean operative time was 186 ± 68min, mean estimated blood loss was 86 ± 64ml, and mean length of stay was 2.4 ± 1.7days. In the majority of cases, patients with acquired diverticula underwent urethral catheter removal between 7 and 14 postoperative days while in the pediatric population with congenital bladder diverticula, Foley catheter removal usually occurred on postoperative day one. We conclude that a robotic technique is a feasible minimally invasive approach for bladder diverticulectomy. Potential benefits may include precise dissection of adjacent structures, as well as easier intracorporeal suturing. Further studies are needed to compare outcomes and costs versus other existing procedures.

Robot-Assisted Bladder Diverticulectomy in the Pediatric Population

Surgical intervention is warranted for symptomatic congenital bladder diverticula (CBD) in children. We hypothesized that a robot-assisted approach to bladder diverticulectomy could be performed with safety and with good efficacy. Descriptions of our approach and results with robot-assisted laparoscopic bladder diverticulectomy (RALBD) are presented. We retrospectively reviewed a prospective database with Institutional Review Board approval. Eligible patients were those who underwent excision of a bladder diverticulum via a robotic approach. Data were collected on presenting symptoms, and intraoperative and postoperative courses. Voiding cystourethrography (VCUG) was performed at 3-month follow-up. Renal and bladder ultrasonography was performed at 3- and 12-month follow-up. Fourteen patients were identified. Of the 14 patients, 6 also had a history of diurnal enuresis. Mean patient age was 7.9 years (range 4-13 years). The operation was performed via a transperitoneal approach with robot assistance. The mean operative time (including cystoscopy) was 132.7 minutes (range 113-192 min). The average length of stay was 24.4 hours (range 18-31 hours). There were no intraoperative or postoperative complications in this group. Each patient was followed for at least 1 year. All patients had a normal results of VCUG on follow-up without evidence of a diverticulum. Within 3 months, diurnal enuresis resolved in 6/6 patients. RALBD appears to be a safe and effective modality for treatment of patients with CBD. It can serve as an alternative to the open surgical approach.

Robot-assisted laparoscopic bladder diverticulectomy in a seven-year-old child: Case report and points of technique

Congenital bladder diverticulum is an uncommon anomaly of the bladder. Patients can present with urinary infection, heamaturia, and/or urinary obstruction. We report the case of a seven-year-old boy who presented with painful micturition and terminal haematuria due to a congenital bladder diverticulum. Robot-assisted laparoscopic diverticulectomy was performed. The patient had an uneventful recovery. We describe the points of technique pertinent to the procedure.

Congenital bladder diverticulum presenting as bladder outlet obstruction in infants and children

PurposeCongenital primary bladder diverticulum is a rare cause of infra-vesical obstruction. We present a series of 12 cases who presented with urinary retention secondary to a large primary bladder diverticulum. The aim is to high light the diagnostic difficulties and management issues of congenital bladder diverticulae. MethodsWe reviewed the case sheets of 12 patients with congenital bladder diverticulae who presented as lower tract obstruction with or without infection at a tertiary care centre in the last 10 years. All patients had urine examinations (complete microscopic with culture), serum creatinine, ultrasonography, intravenous urogram, voiding cystourethrogram with or without cystoscopy. The cases were managed by extravesical mobilization of diverticulae, diverticulectomy, and ureteric re-implantation. All patients (aged 1–36 months, mean 16.8 months) presented with retention of urine but 4 of them had symptoms of fever, tachycardia, abdominal distension and vomiting. Serum creatinine was normal in 10 out of 12 cases, but was high in two. Urine cultures grew Escherichia coli in 5 cases. Ultrasonography showed moderate to severe hydronephrosis on the left side in 5 cases, on the right side in 4 cases and bilateral in 3 cases but diverticulae could be located in only 8 cases. Intravenous urogram revealed hydrouretero-nephrosis in 9 cases, a poor functioning kidney with hydrouretero-nephrosis in 3 cases and bilateral hydrouretero-nephrosis in 3 cases. A Voiding Cystourethrogram confirmed the diagnosis in all cases. Vesicoureteric reflux (Grade 4–5) into the ipsilateral ureter was seen in 9 children of which it was bilateral in three cases. ResultsAll children underwent extravesical diverticulectomy with re-implantation of the ipsilateral ureter in 9 cases, bilateral in 3 cases. All had an uneventful recovery except for one who had a suprapubic leak which healed on conservative treatment. Postoperative ultrasonograms showed mild hydronephrosis in 2 cases and micturating cystourethrograms revealed a grade III V-U reflux in one case which was managed conservatively. Patients are maintaining a sterile urine culture after a follow up of 6–36 months. ConclusionPrimary bladder diverticulum should be kept as a differential diagnosis in cases of bladder outlet obstruction in infants and children. A carefully done voiding cystourethrogram is the hallmark of diagnosis. Good results can be achieved by diverticulectomy and primary definitive repair with ureteric re-implantation even in infants.