How does a diverticulum form?
The wall of the bladder consists of muscle bundles covered from the inside with mucous membrane. When an obstacle occurs in the path of urine outflow, the bladder has to contract with great effort. The pressure inside increases, the muscle bundles thicken and diverge, and the mucous membrane protrudes out through the resulting gaps.
This is how a false diverticulum is formed - a sac, the wall of which consists almost exclusively of mucous membrane without a full muscle layer. It cannot contract, so urine that gets inside stagnates.
There are also true congenital diverticula, containing all layers of the wall. They are less common, are usually found in children and are often located near the ureteral orifice, causing reflux.
Reasons
- Prostate adenoma is the leading cause in men
- Urethral stricture
- Bladder neck sclerosis
- Neurogenic bladder with detrusor-sphincter dyssynergia
- Congenital posterior urethral valves in boys
- Congenital diverticula
- Consequences of bladder surgery
Symptoms
- Often there are no symptoms - a diverticulum is detected on ultrasound during examination for adenoma
- Biphasic urination: immediately after emptying, the urge appears again, and a second portion is released
- Feeling of incomplete emptying
- Recurrent urinary tract infections
- Cloudy urine, unpleasant odor
- Blood in urine
- Pain in the lower abdomen
- Urinary retention
- Symptoms of the underlying disease: weak stream, straining, night rises
Why is it dangerous?
- Chronic urinary stagnation and constant inflammation
- Stones inside the diverticulum
- Recurrent cystitis and pyelonephritis
- Vesicoureteral reflux when located near the orifice of the ureter
- Hydronephrosis and kidney damage
- Tumor in the diverticulum - due to prolonged contact of stagnant urine with the mucous membrane; is detected worse and is more severe due to the thin wall
- Diverticulum rupture due to trauma is a rare but serious complication.
Diagnostics
- Ultrasound of the bladder during filling and after urination - an additional reservoir of urine is visible
- Cystoscopy - examination of the mouth of the diverticulum and its cavity, assessment of the mucosa
- CT cystography or MRI - exact dimensions, location, relationship to the orifices of the ureters
- Vaccine cystourethrography
- Uroflowmetry with determination of residual urine
- TRUS of the prostate and PSA in men
- Urine culture
- Biopsy for suspicious changes in the mucosa inside the diverticulum
An important detail: with ultrasound, the volume of residual urine may be underestimated if the device does not “see” the contents of the diverticulum, therefore, if it is suspected, additional visualization is needed.
Treatment
- Elimination of the cause of urinary stagnation is a mandatory element: TUR of the prostate, HoLEP, urethrotomy, treatment of neurogenic dysfunction
- Observation of small asymptomatic diverticulum without congestion and stones
- Dissection of the neck of the diverticulum - endoscopic widening of the narrow entrance so that urine flows back freely
- Diverticulectomy - removal of a diverticulum; performed openly, laparoscopically or robotically
- Simultaneous removal of stones from the diverticulum cavity
- Reimplantation of the ureter when the diverticulum is located at its mouth
- Antibacterial therapy for infection
Observation
- Control ultrasound with determination of residual urine
- Periodic urine tests and cultures
- Cystoscopy according to indications - especially if there is blood in the urine
- Kidney condition monitoring: creatinine, ultrasound
- Treatment and prevention of urinary tract infections
- Regular monitoring by a urologist for persistent prostate adenoma
Where is treatment in Tashkent
A full range of capabilities is required: cystoscopy, endoscopic operating room for prostate intervention and surgery for diverticulectomy.
In Tashkent, examination and surgical treatment of bladder diverticulum is carried out at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
If you have a prostate adenoma and an ultrasound shows a diverticulum, discuss with your urologist a one-time solution to both problems - this will save you from re-hospitalization. Clinic contacts are below on the page.
