How to treat bladder diverticulum

Many people don't have a particularly good understanding of bladder diverticula. Bladder diverticula refer to a sac that bulges outward from the muscle layer of the bladder wall. Bladder diverticula are divided into secondary and congenital. Congenital ones contain muscle fibers, while acquired ones often lead to urinary tract obstruction, which has a relatively large impact on health. It is easy to cause urine retention, the formation of stones, and even the occurrence of bladder diverticula cancer.

How to treat bladder diverticulum

Conservative treatment is mainly to relieve lower urinary tract obstruction and control infection. The current preference is to first perform transurethral diverticulum neck incision + diverticulum mucosal electrocautery to drain the urine from the diverticulum, especially for elderly patients with more comorbidities, patients with a history of abdominal surgery or radiotherapy, and patients receiving anticoagulant therapy.

If the effect is not good, consider open or laparoscopic/robotic-assisted laparoscopic diverticulectomy. If the diverticulum is huge, and the ureteral opening is close to the diverticulum or opens in the diverticulum, diverticulectomy is required, and ureterovesical reimplantation is performed to prevent reflux. Attention should be paid to repairing the muscle defect in the bladder part of the ureteral opening. The diverticulum does not need to be removed.

complication

Diverticula are mostly located at the bottom and sides of the bladder, with weak walls. They may be infiltrated by inflammatory cells due to infection, and may also be complicated by stones and tumors. The enlargement of the diverticula can also compress the ureter, causing it to shift and cause obstruction. If the obstruction develops further, the increased intracystic pressure may cause a decrease in glomerular filtration rate, a decrease in urine volume, and obstruction in the excretion of creatinine and urea nitrogen. In severe cases, renal insufficiency or renal failure may occur.

There are currently few reports of bladder diverticulum rupture, and its symptoms are consistent with bladder rupture. Urothelial cell carcinoma of the bladder diverticula is also rare and presents mainly as painless gross hematuria.

Clinical manifestations

If there are no complications, bladder diverticulum has no special symptoms. If there is obstruction or infection, symptoms such as difficulty urinating, frequent urination, urgency, and urinary tract infection may occur. Some diverticula can compress the bladder neck and urethra, leading to lower urinary tract obstruction. The lack of muscle contraction in the diverticulum can lead to poor urine drainage, which is easily accompanied by ureterovesical reflux, unilateral or bilateral hydronephrosis, and ultimately lead to renal failure.

There are also cases of congenital giant diverticula without urinary tract obstruction. Because there are very few muscle fibers in the wall of the bladder diverticulum, urine in the giant diverticulum cannot be discharged during urination, and secondary urination symptoms may occur. Some patients have hematuria due to infected stones in the diverticulum. A small number of patients may have urinary retention due to compression of the bladder outlet by the huge diverticulum located behind the bladder neck, which can compress the rectum and cause constipation, and compress the uterus and cause dystocia.