What is a bladder diverticulum?
The bladder diverticulum can be defined as an asymptomatic outpouching that appears at the level of the urinary bladder. It is possible that the bladder diverticulum can lead to further health problems, such as recurrent urinary tract infections or, in worse situations, cancer of the bladder. This condition can either be congenital (only one pouch present) or acquired (multiple pouches), being most often diagnosed at an early age. In many situations, the bladder diverticulum is identified through the prenatal ultrasound.
When it comes to the acquired bladder diverticulum, you should know that this condition is often encountered in elderly men. Also, it is often associated with the benign prostatic hyperplasia. In both situations, practically, the mucosa of the bladder herniates through the bladder wall. The size of the bladder diverticulum can vary tremendously from one patient to the other. In terms of age peaks, there are two to be considered – 10 years and 60-70 years.
Symptoms
There are many bladder diverticulum that do not cause any symptoms. However, for the symptomatic cases, these are the most common symptoms of the bladder diverticulum:
- Urinary retention (inability to urinate)
- Urinary tract infection
- Hematuria (blood in the urine)
Causes
The congenital bladder diverticulum is caused by the poking of the bladder lining into a weak part of the bladder wall.
These are the most common causes that lead to the appearance of the acquired bladder diverticulum:
- Enlarged prostate (leads to the obstruction of the bladder outlet)
- Urethral stricture (scar tissue present in excess)
- Neurological disease
- Nerve injury
- Prior bladder surgery
Diagnosis
In general, this condition is diagnosed incidentally, upon performing imaging studies (CT, ultrasound) for other conditions. However, if a bladder diverticulum is suspected, the doctor might recommend more specific tests. Among these tests, there are: cystography (the bladder is injected with contrast dye and then an X-ray is performed) and cystoscopy (a scope is placed into the bladder through the urethra, thus allowing for the visualization of the diverticulum, if any). These two specific tests are commonly used for the confirmation of the diagnosis.
Treatment
If the bladder diverticulum does not cause any symptoms, no treatment is required (be it congenital or acquired). However, if the condition does cause symptoms, being associated with gall stones, urinary tract infections or urinary reflux, treatment becomes necessary. The condition can also be associated with bladder cancer, hence the importance of the treatment. The risk for complications, such as intra diverticular transitional cell carcinoma, varies between 1 and 10%.
The main purpose of the treatment is to provide relief from the obstruction. Then, the doctor will work on removing the bladder diverticulum. There are two approaches used for such surgeries, meaning the open and the laparoscopic approach. The open approach can be performed in three different ways, meaning extravesical, intravesical or combined.
The laparoscopic approach presents a series of advantages – being minimally invasive, it provides a better and a shorter recovery. Small incisions are made in order to allow for the surgical instruments to operate on the diverticulum and also for the camera to expose the operating field. The laparoscopic approach is considered as a suitable alternative to the open surgery, especially since the operative bleeding is minimal. The approach remains of limited usage in patients who present associated pathologies. Other factors that influence the choosing of a certain surgical approach include: size of the prostate, morphology, size of the diverticulum, surgical history of the patient.
More recently, the da Vinci Robot Surgical System was used for the treatment of the bladder diverticulum. This is considered a minimally-invasive procedure, which have proven to be more than successful in solving such health problems. The robotic technology is perfect for operating in such a delicate area such as the bladder, providing a better outcome and a reduced risk for associated complications. Also, the recovery period is shorter and better. The patient experienced significantly less pain after the surgical intervention, which allows for the almost-immediate return to daily activities.
Prognosis
In general, the treatment for bladder diverticulum provides exactly the expected results, with the symptomatology being completely eliminated. Micturition improves after the surgical intervention in the majority of the patients. The patient will have to visit the doctor on a regular basis, so as to ensure that the emptying of the bladder undergoes as it should.
In the situation that the bladder diverticulum was removed through the open approach, the patient will have to wear a urinary catheter for one or two weeks. In case of complications, with the bladder functioning poorly or the obstruction being long-term, intermittent catheterization might be required for the emptying of the bladder. In rare situations, the patient can suffer from additional complications, such as injuries of the intestines or rectum. Another complication of this condition is represented by the rupturing of the bladder.