Bladder diverticula are protuberances on the bladder wall that have the shape of a sac. It is important to distinguish between true diverticula and pseudodiverticula.
What are bladder diverticula?
Bladder diverticula or bladder diverticula are sac-like protuberances that appear on the wall of the urinary bladder. Depending on whether only the urinary bladder mucosa or all layers of the wall prolapse, there is talk of true diverticula or pseudodiverticula. Doctors differentiate bladder diverticula according to whether the diverticula are congenital or acquired over the course of life.
Congenital bladder diverticula affect the entire wall of the bladder. As a result, the structure of the diverticular wall resembles that of the bladder wall. The congenital bladder diverticula can be found on the muscles of the bladder wall, more precisely on the hiatus uretericus. Acquired bladder diverticula are also called pseudodiverticula. They occur at muscular weak points of the bladder mucosa.
Causes
In some cases, bladder diverticula have been present since birth. They are often associated with vesicoureteral reflux. Specific symptoms usually appear from the age of 10. A common cause of diverticulum formation is congenital weaknesses in the wall of the urinary bladder. This applies primarily to the ureteral orifice. In addition, malformations of the urachus in the roof of the bladder can be responsible for congenital diverticula.
However, some bladder diverticula are diverticula in which all layers of the wall are herniated. Acquired bladder diverticula usually form as a result of neurogenic diseases of the urinary bladder. In most cases, this leads to constantly increased pressure in the bladder of the person concerned. This pressure causes the mucous membrane of the bladder to bulge through open areas in the muscle wall.
The most common triggers include neurogenic dysfunction such as detrusor sphincter dyssynergia, benign enlargement of the prostate (prostate gland) that affects older men over the age of 50, and urethral valves that occur in children. Likewise, an insufficient bladder suture can be responsible for the formation of a diverticulum.
Congenital bladder diverticula include both true diverticula and pseudodiverticula. In some cases, the ureter (ureter) opens into the diverticulum. The term pseudodiverticula is used when not all layers of the bladder wall are herniated. The wall of the diverticulum is made up of connective tissue, mucous membrane and some smooth muscle parts.
Also, as the diverticulum is formed, a pseudocapsule is formed around its wall. This is helpful in the resection of the diverticulum. A diverticular neck that is narrow and sphincter-like is also considered typical. It has an amplifying effect on urinary stasis within the diverticulum.
Symptoms, Ailments & Signs
Since bladder diverticula do not cause any specific symptoms, they often go unnoticed by the people affected. Sometimes, however, urine can accumulate in a pocket-shaped diverticulum. This amount is unaffected by the passing of urine during urination. Due to the residual urine, patients often feel that they have not completely emptied their bladder.
In addition, bladder diverticula can be responsible for chronic urinary tract infections. In some cases, urinary stones even form within the diverticula. Only extremely rarely does a tumor develop on a diverticular floor.
Diagnosis & History
To diagnose bladder diverticula, the treating physician first reviews the patient’s medical history (anamnesis). This is followed by a physical examination. Carrying out imaging examination methods such as an X -ray contrast agent examination is considered helpful for the diagnosis.
A sonography (ultrasound examination) is also useful. In this way, the bladder diverticula can be easily identified when they are full. The diagnosis can be confirmed by a voiding cystourethrogram (MCU). Assessing the extent of diverticular filling after voiding has stopped is considered important. In the course of a cystoscopy (bladder reflection) both the diverticulum and the urinary bladder mucosa can be assessed.
If certain sections appear suspicious, a biopsy (tissue removal) can be performed. If the bladder diverticula are treated, this results in a positive course in most cases. So they can usually be removed without major problems. In the case of congenital diverticula, no therapy is often necessary at all if there is no vesicorenal reflux.
Complications
In most cases, bladder diverticula do not cause any particular discomfort or pain. This disease is therefore only rarely recognized or specifically diagnosed, so that in most cases early treatment of bladder diverticula is not possible. Likewise, the patient’s urination is unaffected by the disease, with the amount not changing either.
However, the affected person always feels that the bladder has not been completely emptied. In the long run, this feeling can lead to psychological problems or depression and has a negative effect on the patient’s everyday life. It is not uncommon for those affected to drink less so that they do not urinate frequently. The bladder diverticula increase the risk of kidney stones forming, so that these can also occur as the disease progresses.
The treatment of bladder diverticula usually does not lead to any complications. In most cases, surgical interventions are used to resolve the symptoms. In severe cases, the patient is dependent on a catheter, which restricts everyday life relatively severely. Life expectancy is usually unaffected by the disease.
When should you go to the doctor?
If, after urinating, you keep having the feeling that your bladder has not been completely emptied, you may have a bladder diverticulum. A doctor should be consulted if the symptoms have not subsided after a week at the latest. If signs of a urinary tract infection appear, medical advice is required. Urinary stones can also indicate a diverticulum and should be examined by a urologist or internist and removed if necessary.
If a bladder diverticula is not removed, a tumor can develop in the worst case. The warning signs for such a severe course include pain and retention when urinating, frequent urge to urinate and increasing pressure pain in the area of the urinary bladder.
If you notice these symptoms, you must speak to your family doctor immediately. If the symptoms are severe, a visit to the hospital is indicated. In case of doubt, the medical emergency service can be contacted first. In general, a bladder diverticula must be clarified and removed in order to enable a speedy recovery and to avoid further complications.
Treatment & Therapy
Various measures are used to treat bladder diverticula. Permanent catheterization is performed in patients for whom surgical removal appears too risky. In some cases, intermittent self-catheterization is also possible. Treatment with an endoscope can be used to perform a resection of a diverticular neck that is too narrow.
This method is used for borderline significant diverticula. In addition, coagulation takes place, which initiates scarring shrinkage of the bladder diverticulum. In most cases, surgery is performed with the goal of removing the bladder diverticula, especially large diverticula. Different methods are used for this.
Smaller diverticula are treated by open surgical transvesical diverticulum resection. This often occurs in connection with a transvesical prostate adenomectomy. Extravesical diverticulum resection can be considered as a further surgical treatment method. It is particularly suitable when larger bladder diverticula occur.
This method is either minimally invasive through a laparoscopy performed (laparoscopy) with a special endoscope or open-ended fashion. This depends on whether ureteral implantation or prostate deobstruction is required at the same time.
Outlook & Forecast
The prognosis for bladder diverticula is good. If they are discovered and treated early, the symptoms will be free within a short period of time. In a large number of cases, surgical interventions are carried out to completely remove the foreign body. Like any operation, this one is associated with the usual risks and side effects. If there are no complications and the wound heals well, the patient can usually be expected to recover within a few weeks.
In the case of smaller bladder diverticula, laser treatment is often sufficient. The foreign bodies are shattered by the effects of the laser beam and are then transported out of the body and excreted independently by the organism.
If there is no restructuring of the living conditions and the health care of the patient, a recurrence of the bladder diverticula is likely. If the foreign bodies appear again, the prognosis is also good. The sooner the diagnosis is made, the better and simpler the therapy.
Without treatment, the symptoms will continue to increase. In severe cases, a backlog of urine is to be expected. Bacteria and germs develop as a result, so that secondary diseases develop. In addition, organ damage is possible, which always poses a potential threat to life and contributes to a shortening of the expected lifespan of the patient.
Prevention
Since bladder diverticula are often congenital, there are no suitable preventive measures. In order to counteract acquired bladder diverticula, the triggering diseases would have to be avoided, but this is difficult.
Aftercare
The diagnostic measures are usually dependent on the severity of the diverticula, so that no general prediction can be given. In general, an early diagnosis and recognition of the symptoms has a very positive effect on the further course of the disease, so that the person concerned should contact a doctor as soon as the first symptoms and symptoms appear.
The earlier the disease is recognized by a doctor, the better the further course is in most cases. In most cases, the person affected by this disease is dependent on a surgical procedure, which can alleviate the symptoms in the long term. Bed rest should be observed after such a procedure, during which the sufferer should be resting and avoiding stressful or physical activities.
Regular check-ups and examinations by a doctor are also very important after a successful procedure and can prevent further complications or symptoms. The life expectancy of those affected is usually not reduced by the disease. After surgery, antibiotics should be taken to prevent infection or inflammation. It is important to ensure that the dosage is correct and that it is taken regularly.
You can do that yourself
If a urinary bladder diverticulum has been identified, the patient should first and foremost rest until the diverticulum is surgically removed or treated with the help of an indwelling catheter.
Post-diagnosis arrangements must also be made for hospitalization. The urinary bladder must not be put under any further strain in order to avoid an increase in symptoms and possible complications. Patients should therefore make sure that they do not get a cold or any other illness that could cause additional damage to the bladder or urinary tract.
From there, the usual measures must be taken. Relatives and friends must be informed about the hospital stay, as well as the employer and the health insurance company, which usually covers the costs of the procedure.
After an operation, the person concerned should take it easy at first. The surgical wound needs at least a week to heal. After that, you can slowly return to everyday life. When you can go back to work depends on the type of treatment and the course after the procedure. It is best to talk to the responsible doctor and clarify any activities in advance.
