Diverticula In Children Research Articles

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.

Internal Auditory Canal Diverticula in Children: A Congenital Variant.

Internal auditory diverticula in adults have been found to exist independent of otosclerosis, and in the presence of otosclerosis. We sought to determine the prevalence of internal auditory canal (IAC) diverticula in a pediatric cohort, to assess whether IAC diverticula are a risk factor for hearing loss, and the co-occurrence of otic capsule hypoattenuation. Retrospective review. A single-site retrospective review of high-resolution temporal bones computed tomography (CT) scans including the presence and size of diverticula and hypoattenuation of the otic capsule. Demographic, imaging, and audiometric data were collected and descriptively analyzed. Bivariate analysis of collected variables was conducted. Comparisons between sides in unilateral cases were also performed. 16/600 (2.7%; 95% CI [2.0%, 3.4%]) were found to have IAC diverticula. Six were bilateral. Thirty-one patients (5.2%) were found to have hypoattenuation of the otic capsule. There were no coincident cases of IAC diverticulum and hypoattenuation of the otic capsule. There was no association between the presence of IAC diverticula and age (P = .13). In six patients with unilateral diverticula, pure tone average (P = .42), and word recognition (P = .27) scores were not significantly different when compared to the normal, contralateral side. The prevalence of IAC diverticula in children is lower than the prevalence in adults. IAC diverticula in children likely represent congenital variants of temporal bone anatomy. Similar to adult populations, there is evidence that IAC diverticula in children are likely not an independent risk factor for hearing loss. 4 Laryngoscope, 131:E1683-E1687, 2021.

Calyceal diverticula in children: Imaging findings and presentations

A calyceal diverticulum consists of a cystic eventration in the renal parenchyma that is lined with transitional cell epithelium with a narrow infundibular connection with the calyces or pelvis of the renal collector system; thus, the term pyelocalyceal diverticulum would be more accurate. Very rare in pediatric patients, calyceal diverticula can be symptomatic and require treatment. Calyceal diverticula are underdiagnosed because they can be mistaken for simple renal cysts on ultrasonography. To determine the approach to their follow-up and management, the diagnosis must be confirmed by excretory-phase computed tomography (CT) or magnetic resonance imaging (MRI).This article aims to show the different ways that calyceal diverticula can present in pediatric patients; it emphasizes the ultrasonographic findings that enable the lesion to be suspected and the definitive findings that confirm the diagnosis on CT and MRI. It also discusses the differential diagnosis with other cystic kidney lesions and their treatment.

Optimizing surgical resection of the bleeding Meckel diverticulum in children

PurposeMeckel diverticula containing gastric heterotopia predispose to local hyperacidity, mucosal ulceration, and gastrointestinal bleeding in children. Eradication of acid-producing oxyntic cells is performed by either of two surgical methods: segmental enterectomy including the diverticulum or diverticulectomy only. MethodsRetrospective review of all children having surgical resection of a Meckel diverticulum at a tertiary-referral children's hospital from 2002 to 2016 was performed. Demographic data, surgical method, pathological specimens, and outcomes were evaluated. Results102 children underwent surgical resection of a Meckel diverticulum during the study period. 27 (26.5%) children presented with bleeding, of which 16 (59%) had diverticulectomy only, and 11 (41%) had segmental ileal resection. All Meckel diverticula in children presenting with bleeding contained gastric heterotopia, and resection margins were free of gastric mucosa. Histologically, 19 specimens showed microscopic features of ulceration, on average 2.95mm (SD 4.49) from the nearest gastric mucosa (range: 0–16mm). Mean length of hospitalization after ileal resection was 4.0days (SD 1.2) compared to 1.6days (SD 0.9) for diverticulectomy only (p<0.001), with no re-bleeding occurrences. ConclusionIn the operative management of children having a bleeding Meckel diverticulum, diverticulectomy-only completely eradicates gastric heterotopia without increased risk of continued bleeding or complications and significantly shortens hospitalization. Level of evidenceTreatment Study: Level III.

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.

Current diagnosis and management of primary isolated bladder diverticula in children

Primary isolated bladder diverticula (PIBD) that are not correlated with the UVJ comprise approximately 10% of all primary bladder diverticulas (PBDs). No guidelines have been established for PIBD repair. It is unknown if infections or voiding dysfunction are impacted by the size of diverticula. We evaluated the most effective approach to treating PIBD with respect to diverticula size and objective clinical and urodynamic findings. We retrospectively evaluated age, sex, chief complaint, UTI diverticula size, clinical and urodynamic findings, and management of 14 consecutive patients diagnosed with PIBD from 1995 to 2013. Urodynamic studies were performed in all PIBD cases, Post micturition residue (PMR), maximum bladder capacity (MBC), voiding detrusor pressure (Pdet), and pressure flow (Qmax) were all measured. Among patients who underwent surgical repair, resected diverticula wall specimens were sent for pathological evaluation. Twelve boys and two girls ranging in age from 2 to 15 years (mean, 6.7 years) were included in this study. The mean follow-up duration was 54.2 months (range, 6-120 months). All diverticula were single, and most occurred in posterolateral locations (Figure). In eight patients with PIBD of <3 cm (range, 15-24 mm; mean, 18 mm), MBC, P det, and Qmax were within reference ranges. None of the patients had PMR, and most developed only one urinary tract infection (UTI) before admission. All patients underwent close follow-up without surgical intervention. Six patients had diverticula of >3 cm (range, 32-72 mm; median, 48 mm). Their MBC was lower (72% of predicted value) than the reference range. The P det was significantly higher than that of patients with diverticula of <3 cm and the Q max was lower in two patients. Four patients had PMR, and all patients developed at least three UTIs before admission to the hospital. This group of patients was treated surgically. All operated children reported improvement after in control urodynamic study over follow-up periods. The diverticula layer lacks the contractility that allows the diverticulum to appropriately void into the bladder. This accounts for the urinary retention and dysfunctional voiding. The patients with diverticula larger than 3 cm had PMR. Members of this group had more than three UTIs. In our series, diverticula of >3 cm exhibited an MBC that was lower than the predicted values. The detrusor contracts, but the urine enters the diverticula more easily than it enters the bladder neck. This could inhibit bladder enlargement and may explain the lower MBC in this group. This group also had higher Pdet, and their q max was low. Thus, probably simulating detrusor much higher pressure but undercontractility due to diverticulum. Another possible explanation could be that large PIBD creates a functional obstruction over the bladder neck during voiding. PIBD of >3 cm is characterized by UTI development, functional lower urinary tract symptoms, and disorders of bladder storage or emptying. Surgical repair of these diverticula is associated with improvement of voiding dysfunction and elimination of UTIs.

Giant bladder diverticulum in a boy

Although the bladder diverticula in children are seen commonly which is association with infravesical obstruction or neurogenic bladder function, the case of giant congenital bladder diverticula are rare. In this paper, an 11 years old boy with giant bladder diverticula presenting urinary infections is evaluated in terms of diagnosis and management by current literature.

Uncommon causes of anterior urethral diverticula in children: Two cases and review of literature

Anterior urethral diverticula are rare in children. Anterior urethral valves and associated diverticulum is the commonly discussed pathological entity in children. There is a lack of awareness among clinicians regarding less common presentations of anterior urethral diverticula in children; which can have a diverse involvement of the urinary tract. This report describes two uncommon presentations of anterior urethral diverticula in children, their diagnoses and management. A systematic differential diagnosis and review of anterior urethral diverticula in children is also presented.

Congenital bladder diverticulum with benign bladder wall lesion resembling rhabdomyosarcoma.

Congenital bladder diverticula in children are uncommon and rarely present with bladder outlet obstruction. We present a case highlighting an interesting association between a congenital bladder diverticulum and a benign inflammatory bladder wall lesion mimicking a rhabdomyosarcoma. Open surgery was required as different imaging modalities and cystoscopy were insufficient to exclude a malignant process.

Pneumovesicoscopic Treatment of Congenital Bladder Diverticula in Children: Our Experience

In this article, we report our experience with diverticulectomies of symptomatic congenital bladder diverticula in children, which was performed by utilizing pneumovesicoscopy. Six boys, 4-8 years of age (mean, 5.6) underwent pneumovesicoscopic diverticulectomy at our institution from June 2007 to June 2008. There were 4 right-single diverticula and 2 double-left diverticula. Under cystoscopic control, after the cystopexy to the abdominal wall, a midline 5-mm trocar for a 0-degree telescope and two lateral 3-mm reusable trocars through the anterolateral wall of the bladder in the midclavicular line were introduced, insufflating the bladder with carbondioxide to 10-12 mm Hg pressure. The diverticulum/a were inverted into the bladder and the mucosa around the neck was circumcized by using scissors and a monopolar hook. The defect was sutured with interrupted sutures and the bladder was drained with a Foley catheter, which was introduced at the site of the 5-mm port, and a urethral catheter. Mean operative time was 110 minutes. No major peri- or postoperative complications were recorded, except that the displacement of one of the lateral trocars that resulted in gas leakage in 1 case. The trocar was replaced and the procedure was completed. An ultrasound and a voiding cystourethrogram, performed from 3 to 6 months after the operation, showed the disappearance of the diverticulum/a. In our experience, pneumovesicoscopic diverticulectomy is an easy, safe procedure and can be considered a valid alternative to the open or laparoscopic procedures. It also provides no postoperative discomfort and a good cosmetic result.

Caliceal Diverticula in Children: Natural History and Management

The natural history of caliceal diverticula in children is unknown. We review our series of children with caliceal diverticula to examine the presentation, natural history and management. We retrospectively reviewed the records of 22 children presenting with caliceal diverticula between 1983 and 2006. All pertinent clinical data were recorded, including demographics, imaging studies, treatment and clinical outcome. A total of 22 children had 23 caliceal diverticula. There were 14 girls and 8 boys who presented at a mean age of 5.4 +/- 3.1 years (range 0.2 to 12). At clinical presentation 10 patients had febrile urinary tract infection, 2 had hematuria, 2 had abdominal pain, 1 had flank pain and 8 were asymptomatic. Mean diameter of all caliceal diverticula was 2.2 +/- 1.7 cm. All patients underwent voiding cystourethrogram. Two patients (9%) had concomitant ipsilateral caliceal diverticula and vesicoureteral reflux. A total of 10 patients with caliceal diverticula (43%) were treated at a mean of 3.0 +/- 2.3 years after initial presentation due to symptomatic enlargement in 5, symptomatic calculus in 3, complicated abscess in 1 and urosepsis in 1. Treatment modalities included percutaneous ablation, open marsupialization/ablation, partial nephrectomy and laparoscopic marsupialization/ablation. There were no recurrences during a mean followup of 3.1 +/- 2.9 years (range 0.1 to 10.1) in these 10 patients. In the 13 caliceal diverticula (57%) that were observed mean followup was 6 +/- 3.7 years (range 1.2 to 10.5). These caliceal diverticula were stable in size and remained asymptomatic. Caliceal diverticula in children are rare. Most caliceal diverticula remain stable and asymptomatic but approximately 20% may have symptomatic enlargement that may warrant surgical management. Given the morbidity associated with caliceal diverticula and concomitant vesicoureteral reflux, evaluation for ipsilateral reflux is mandatory. Overall approximately 43% of children with caliceal diverticula require surgical intervention, and various treatment options are available.

Primary Congenital Bladder Diverticula in Children

To present the symptoms, treatment, evolution, and pathologic findings of primary (nonobstructive) diverticula in childhood. Primary (nonobstructive) diverticula are not frequent in childhood. Bladder diverticula have classically been defined as "hernias of the mucosa through muscular fibers of the bladder wall." From September 1985 through September 2005, we treated 11 children categorized has having primary congenital bladder diverticula. At diagnosis, their ages ranged between 7 months and 9 years (mean 4.6 years). Ten were boys and one was a girl. The main reason for consultation was febrile urinary infection (n = 5), recurrent urinary infections (n = 3), enuretic syndrome (n = 1), gross hematuria (n = 1), and pain in the right iliac fossa (n = 1). One child had Ehlers-Danlos syndrome. All the diverticula were larger than 2 cm in diameter. Of the 11 children, 10 underwent surgery. Clinical observation was chosen for the 9-month-old infant. All 10 operated children had developed favorably at a follow-up of 2 to 20 years (mean 9.3). The 9-month-old child continued under observation for 5 years. We observed no diverticulum recurrence and no postoperative vesicoureteral reflux in the reimplanted children. Pathologic examination was performed of the excised diverticula in 7 cases, and muscular fibers were found in all of them; however, most of the fibers were very fine, particularly at the dome of the diverticulum. The results of our study have shown that urinary tract infection is the most common symptom of bladder diverticula. Surgical treatment provided good results, without any recurrence or morbidity. The bladder diverticula were lined with fine muscular fibers.

Anterior Urethral Valves and Diverticula in Children: A Result of Ruptured Cowper's Duct Cyst?

No AccessJournal of UrologyUrological Survey: Pediatric Urology1 Oct 2005Anterior Urethral Valves and Diverticula in Children: A Result of Ruptured Cowper's Duct Cyst? Douglas A. CanningM.D. Douglas A. CanningDouglas A. Canning More articles by this author View All Author Informationhttps://doi.org/10.1097/S0022-5347(01)68666-XAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Anterior Urethral Valves and Diverticula in Children: A Result of Ruptured Cowper's Duct Cyst?." The Journal of Urology, 174(4 Part 1), p. 1445 © 2005 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 174Issue 4 Part 1October 2005Page: 1445 Advertisement Copyright & Permissions© 2005 by American Urological Association, Inc.MetricsAuthor Information Douglas A. Canning More articles by this author Expand All Advertisement PDF downloadLoading ...

Surgical management of primary bladder diverticula in children

Purpose The aim of this study was to review the authors' surgical experience with primary bladder diverticula in the pediatric population, with special attention to associated urinary tract infections and voiding dysfunction. Methods A retrospective review yielded 21 pediatric patients with primary bladder diverticula treated surgically over a 13-year span. Patients with secondary diverticula were excluded. Charts were reviewed and patients were contacted in regards to several factors. Diverticula were diagnosed preoperatively by radiography on a voiding cystourethrogram. Diverticula, which were only found intraoperatively and not on VCUG, were not included in the study. Results Mean age at presentation was 8.16 years (range of 0.17-12.91 years). The sex predominance was male, 17 (81%) of 21. Mean follow-up was 44.2 months (range of 6-156 months). The diverticula were associated with ureters requiring reimplantation in 15 of 21 patients (72.4%); only 6 (28.6%) of 21 were isolated diverticula. Nineteen (90.5%) of 21 patients presented with infections, and all 19 (100%) have had complete resolution of infections. Of the total, a subset of 6 patients with isolated diverticula and no evidence of reflux had total resolution of their infections. Twelve patients presented with voiding dysfunction. Eight of these 12 patients had improvement of their voiding dysfunction with complete resolution in 2 patients. Conclusions In this series, infections were eliminated with surgical excision of the primary diverticula. Surgical repair was also associated with improvement of voiding dysfunction.

Anterior urethral valves and diverticula in children: a result of ruptured Cowper's duct cyst?

To review a series of children with anterior urethral valves and diverticula, to elucidate the pathophysiology and optimal management of this entity. Nine cases (all boys; 1963 to 2003) were reviewed retrospectively. Seven of nine boys had bulbar diverticula. Continuity between Cowper's duct and the diverticulum was noted endoscopically in two and confirmed radiographically in one. Initially, open surgery was curative but more recently endoscopic management has been the procedure of choice. This series indicates that the distal lip of a ruptured syringocele may function as a flap-valve, leading to anterior urethral obstruction. Advances in imaging and endoscopic instruments have altered the mode of presentation and management of this entity.

CONGENITAL BLADDER DIVERTICULUM: A RARE CAUSE OF BLADDER OUTLET OBSTRUCTION IN CHILDREN

The majority of bladder diverticula in children are associated with neurogenic bladder or infravesical obstructive conditions, particularly posterior urethral valves. Congenital bladder diverticulum is not associated with such conditions and is due to inherent muscular weakness rather than obstruction.1 Compared to diverticula associated with obstruction, congenital bladder diverticulum develops in a smooth walled bladder, and is often solitary and larger. This condition may lead to various sequelae, including recurrent urinary tract infection, vesicoureteral reflux, stone formation and incontinence. It may rarely present with bladder outlet obstruction. A case of bladder diverticulum presenting as acute urinary retention is reported.

Congenital bladder diverticula in children

Background/Purpose: The authors report their experience with the management of congenital bladder diverticula in children. Methods: The authors reviewed the histories of six boys (mean age, 4.4 years) in whom congenital bladder diverticula was treated from 1980 to 1996. Diverticula were unilateral in four patients and bilateral in two patients. All patients presented recurrent urinary tract infection, and two boys had several episodes of urinary retention. Secondary kidney damage was present in two patients with ureteral obstruction and one with vesicoureteral reflux. Surgical treatment was undertaken in all patients. Results: After surgical treatment, none of the patients has had recurrence of the diverticula, and all remain asymptomatic. Conclusions: Congenital bladder diverticula have a wide clinical spectrum and could lead to severe kidney damage. Urinary tract infection and urinary retention are the most frequent presentation forms. Surgical treatment should be indicated in all symptomatic cases according to each anatomic and functional situation.

Laparoscopic removal of Meckel's diverticula in children.

We report on 4 children where Meckel's diverticula (MD) were excised laparoscopically. In two of the children the finding of an MD was incidental and in two it was suspected preoperatively. In three of the patients the MD was ligated by means of an "endoloop" and could be removed in a similar manner to an appendix. In one patient the MD was resected by means of a stapler. No complications occurred. Subsequent histology confirmed the complete excision of the MD. Allowing for the size and shape of an MD, we prefer to excise it by means of an endoloop. An endoloop has the advantage that it can be used through a 5 mm trocar while a stapler has the disadvantage that it requires a larger 12 mm trocar and it leaves a foreign body, i.e. metal clips behind.

Bladder diverticula in children.

The frequency, number, and underlying associations of bladder diverticula were studied in a pediatric population. Eighty-five children with bladder diverticula (31 girls and 54 boys) were retrospectively identified in a pediatric genitourinary data base of 5,084 children. Primary bladder diverticula were seen in 20 children with vesicoureteral reflux and 14 children without reflux. Fifty-one of the 85 children (60%) had associated neurogenic dysfunction of the bladder (n = 26), outlet obstruction (n = 14), or a syndrome (n = 9) or were postoperative (n = 2). A single child of the 26 with multiple bladder diverticula had no associated condition. In this population, bladder diverticula were found in 1.7% of the children. The presence of more than one diverticulum on a side was usually associated with neurogenic dysfunction of the bladder, bladder outlet obstruction, or syndromes such as Williams, Menkes, prune-belly, or Ehlers-Danlos type 9 syndromes.

Congenital ureteric diverticula in children and adults: classification, radiological and clinical features

To date, about 100 cases of a blind-ending branch of a bifid ureter have been reported. We present 13 clinically, radiologically and histologically evaluated cases of congenital ureteric diverticulum. We believe this anomaly is not as rare as hitherto believed and suggest the term congenital ureteric diverticulum for a blind-ending branch of a bifid ureter.