Bladder diverticulum - what is it? This is a protrusion in the walls of an organ, presented in the form of a rounded saccular depression and connected to the bladder by its own channel. The disease often affects the lateral or posterior wall of the organ. The additional cavity in the bubble can be small or significant in size, be single or multiple, and also vary in origin. Therapeutic measures to eliminate the pathology are reduced to performing a diverticulectomy.
Causes and classification of the disease
Diverticulums of the bladder are divided into congenital (true), which develop in the mother’s womb under adverse circumstances. With true diverticula, the protrusion has mucous layers of the membrane, submucosal base, is equipped with muscle layers and the outer adventitious membrane. With congenital pathology, single diverticula are formed.
The acquired diverticulum is provoked by a number of diseases in which the emptying of the bladder is difficult. To push out the contents, the muscular walls of the organ constantly tighten, and over time they thicken. The depleted muscle structure of the tissue loses its elasticity, loosening of the fibers forms a protrusion. The acquired diverticulum does not have muscle layers - they form under the mucous membrane. Acquired protrusions are often multiple, resembling a hernia.
Congenital diverticula develop for the following reasons:
- Gene mutation of the fetus.
- Radiation and adverse ecology.
- Presence of bad habits in the mother.
- Past infectious diseases during pregnancy.
- Frequent stresses.
Reason for acquired diverticula in male patients:
- An inflamed prostate gland presses on the urethra, blocks the ureter.
- Due to the narrowed lumen of the urethra, formed due to trauma or inflammation.
- Closure of the neck of the organ due to scarring.
Common reasons:
- the presence of stones;
- tumors;
- infectious pathologies;
- intestinal obstruction.
If an infection is attached to the diverticulum, there is a risk of a purulent process with the appearance of an abnormal opening.
Internal pinching of the walls of the diverticulum can disrupt the blood supply to the bladder and lead to aseptic necrosis.
Symptoms of diverticulum of the bladder
The initial stages of the pathology do not differ in pronounced symptoms. The symptoms of a bladder diverticulum are as follows:
- Uncomfortable and prolonged urination process - the bladder is emptied first, and then the diverticulum.
- Frequent urination
- The man has pain, pain in the urethra.
- Turbid urine mixed with cereal and blood.
- Aching, bursting pain, aggravated by the release of the bladder.
- In women, curdled discharge is detected
Diverticulums of the bladder in children
In childhood, pathology is rarely manifested: according to statistics, a diverticulum is found in one out of a hundred children. Often diagnosed with a congenital type of pathology under the age of 6 years. A diverticulum in a child’s bladder creates problem urination and partially or completely retards urine.
The pathology is diagnosed with the help of endoscopic and radiological examinations, during examination, bulging of the abdomen in the area of the projection of the bladder may be detected. Endoscopy allows you to evaluate the diverticulum - its shape, size.
The most accurate diagnostic method is cystography using contrast. In the picture, the protrusion is viewed as an additional cavity. Diverticulums of the bladder in children are located in the area of the mouth of the ureter and can have an oval hemispherical shape that varies in size.
The main indicator of the disease in children, as well as in adults, is dysuria - a disturbed process of urine output. The child may feel incomplete emptying of the bladder, feel abdominal pain. Urination disorder can have a depressing effect on the psyche of the child. Parents should pay attention to prolonged urination in their child. If the baby cries during or after the urination process, then you should seek medical help.
Diverticulum Diagnosis
What is bladder diverticulum and how to treat it? For the diagnosis of the following studies:
- Ultrasound to determine the structural tissue of an organ.
- Cystography with contrast fluid.
- A cystocopy is performed to reveal the opening of the isthmus that connects the diverticulum to the bladder.
- Uroflowmetry is performed with an already established diagnosis to detect subbubble obstruction of the urinary canal. The study also shows how fast urine flows.
- General blood test - to exclude the inflammatory process
In the diagnosis, diverticulum is differentiated with pathologies of the genitourinary organs.
Treatment of diverticulum of the bladder in men and women
If a small diverticulum is detected with no dysuric phenomenon, treatment is not prescribed. The patient should be periodically monitored by a treating urologist.
Treatment of a diverticulum of the bladder does not provide for conservative therapy - protrusion is an irreversible process. To eliminate the pathology, surgical intervention is required. The detection and exclusion of pathology, which provoked the formation of a diverticulum, is important. Treatment of a diverticulum of the bladder in males involves the elimination of existing problems with the prostate gland, urinary tract.
To eliminate the associated infection, uroantiseptic drugs are prescribed. In order to prevent the development of the inflammatory process, antibiotics are prescribed before and after the operation.
Two types of surgical procedures are used, and the method of exposure is selected taking into account the properties of the anomaly, severity, and concomitant disorders. The obvious indication for surgery is:
- constricted neck of the bladder, violating the act of urination;
- swelling and diverticulum stones;
- the presence of supravesical obstruction;
- non-treatable cystitis.
Open Access Operations
Removing the diverticulum is carried out using general anesthesia. During operations, an arched suprapubic incision is made. The tissue surrounding the bladder is excised, while the organ is exposed, through the incisions the diverticulum is brought out and cut off from the bladder. Then it is necessary to establish drainage tubes and suturing the wound. A catheter is inserted and sutured into the urethra to avoid stress when the bladder is empty.
With existing prostate adenoma, adeno- and diverticulectomy are performed simultaneously.
Among the minuses of open surgery can be noted a lot of blood loss and prolonged rehabilitation. In the postoperative period, complications with suppuration of sutures are possible.
Transurethral endoscopic marsupialization
This method involves a smaller area of intervention and has several advantages. Operations are carried out using endoscopic instruments using tissue vaporization. Scorched tissue eliminates bleeding, which contributes to rapid healing. General anesthesia is replaced by epidural or spinal anesthesia.
With the help of an endoscope inserted into the urethra, the isthmus of the diverticulum is determined. Then the neck of the diverticulum is dissected with a special tool to a shallow depth in order to expand the isthmus between the bladder and the protrusion bag. This contributes to the complete outflow of urine from the diverticulum. Parallelization of vaporization eliminates the need for suturing, which significantly reduces the risk of infection of the wound. The operation does not take more than 20 minutes, the rehabilitation period is also shortened. Drainage is removed two days after surgery.
Rehabilitation period
During the rehabilitation period, some recommendations should be observed:
- After an open operation, it is required to monitor the condition of the joints.
- A physiotherapy course will accelerate the recovery of the body.
- Repeated cystography is performed two months after the operation.
- Alcohol, salted, smoked and pickled foods should be excluded from nutrition during the rehabilitation period.
- Drink plenty of water to prevent stagnation of fluid in the bladder.
Treatment of pathology in a child
Treatment of a diverticulum of the bladder in children is carried out endoscopic or by the method of open surgery. Before conducting a diverticulectomy, the localization of the mouth of the ureter is checked. If the ureter falls into the diverticulum, then there will be a need to transplant the ureter into the wall of the bladder. In the postoperative period, the pain syndrome is stopped with non-steroidal and anti-inflammatory drugs, and diet No. 7 is also required.
The prognosis for a similar disease in children depends on abnormal changes in the organ and concomitant infection. With an existing urinary infection, an suprapubic bladder fistula is necessary before the diverticulum ectomy.
After the operation, it is necessary to be observed by a pediatric urologist. Three months later, it is necessary to conduct an ultrasound scan, cystography - six months after the operation.
Reviews of the diverticulum of the bladder in a child in terms of treatment are mostly positive. Removal of a congenital diverticulum in a child is not accompanied by serious complications.
Diverticulum Prevention
To avoid a congenital diverticulum, one should follow the doctor's recommendations throughout pregnancy, treat infectious diseases in a timely manner, and give up alcohol and smoking.
To prevent acquired diverticulums, it is important not to start diseases that impede the outflow of urine and increase the pressure in the bladder. Prevent the formation of stones, narrowing of the urinary canal and avoid diseases of the genitourinary tract.