Bladder diverticula
are pouches in the bladder wall and may be either
congenital or acquired. Congenital
diverticula are generally solitary and are most often discovered
during childhood. Acquired
bladder diverticula are typically the result of obstruction of the
bladder outlet, bladder dysfunction from nerve injury or, rarely, as a
result of prior bladder surgery. Acquired diverticula are often
multiple.
Bladder diverticula
often do not produce specific symptoms but may be associated with
urinary tract infections, difficulty voiding or abdominal fullness,
particularly if they become large causing the bladder to empty
incompletely. Most commonly, bladder diverticula have no direct
symptoms but are incidentally discovered while looking for causes of
other urinary difficulties such as urinary tract infections, trouble
urinating or blood in the urine.
An ultrasound (US) shows
hypoechogenic rounded zone beside the bladder with different size. An
urinating cystogram of the bladder is an
excellent way of detecting bladder
diverticula. Diverticula may also be found by cystoscopy, which is
important for checking that no bladder tumors are found in the
diverticulum. The function of the bladder and the presence of
obstruction of the bladder outlet may be assessed with an
urodynamics .
Congenital or acquired diverticula do not always
require treatment, particularly if they are not associated with
reccurent urinary infections, bladder
stones, vesiculo-ureteral reflux, bladder
tumors or difficult voiding.
We present a 6-months old
boy with asymtomatic bacteriuria, found during prophylactic
investigations. Antibiotic treatment was performed and after that
afebrile bacteriuria occurred again. US was made and an anechogenic
formation beside the bladder was found. For that reason the child
was hospitalized in our clinic. Our US images confirmed the
diagnosis, but urinating cystogram was performed to visualize the
connection between the diverticulum and the bladder. The laboratory
results of the blood, the renal function and the urine were normal.
The microbiologic tests of the urine- also normal. Because of the
little age of the child urodynamic investigation was not performed at
that time. We started with uroantiseptic prophylaxis, counseled the
mother to remove the diapers and during the next year the child had
no problems. The observation continues.
