Introduction:
The urinary bladder is an empty, pouch-like organ that stores the urine formed by the kidneys. Bladder trabeculation is when the bladder walls become thick and hard, making it difficult to contract. This thickening leads to incomplete emptying of the urinary bladder during urination. Bladder trabeculation can occur in men and women, obstructing the urethra.
What Are the Causes of Bladder Trabeculation?
The urinary bladder is a hollow, sac-like organ located in the lower abdominal area that stores urine. It is held in place with the help of other organs and ligaments. The bladder expands and contracts to drain the urine out of the body. Repeated urethral blockage can lead to bladder trabeculation. Urethral blockage can occur due to -
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Conditions present since birth.
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Structural abnormalities result in the narrowing or blocking of the urethra.
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Presence of polyps or benign tissue growth.
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Presence of blood clots that put pressure on the bladder walls.
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A large amount of hardened stool accumulates in the digestive tract (fecal impaction).
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An enlarged prostate gland presses on the urethra and blocks the urine flow.
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Presence of tumors.
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Neurogenic Bladder - Neurogenic bladder occurs when the nerves controlling the urinary bladder do not work appropriately. This can lead to bladder trabeculation.
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Surgical Intervention for an Enlarged Prostate - Surgery for an enlarged prostate gland removes excess prostate tissues. During the surgery, blood clots can also form in the bladder, blocking the urethra, thus preventing urination.
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Pelvic Organ Prolapse - Pelvic organ prolapse occurs when specific pelvic organs move from their original position and project out through the vagina. The prolapse can cause urinary tract problems that might affect urine flow.
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Hydronephrosis - Hydronephrosis is the swelling of the kidneys due to the accumulation of urine. Females can develop this condition during pregnancy when the uterus puts pressure on the ureter. Specific hormonal changes can also lead to hydronephrosis.
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Bladder Trabeculation in Children - In kids, bladder trabeculation is caused by congenital bladder conditions or conditions present since birth. Some valves in the urethra can become narrow and block the ureter or urethra, leading to bladder trabeculation.
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Bladder Trabeculation in Men - In men, benign prostatic hyperplasia (BPH) can hinder urine flow. This can cause trabeculation in the urinary bladder. This affects men over the age of 50 years of age. Bladder trabeculation also occurs in men after getting laser treatment for an enlarged prostate.
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Bladder Trabeculation in Women - A severe pelvic organ failure can lead to lower urinary tract problems. This causes bladder trabeculation in such women. Older women are more prone to the condition.
What Are the Symptoms of Bladder Trabeculation?
The symptoms of bladder trabeculation include -
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Difficulty in urination.
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Painful urination.
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A feeling that the bladder is not entirely empty.
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Repeated urinary tract infections.
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Pain in the kidneys.
How Is Bladder Trabeculation Diagnosed?
Bladder trabeculation is suspected in case a person is having difficulty in passing urine, has a slowly flowing urine stream, or increased frequency of urination. The healthcare professional diagnoses bladder trabeculation by measuring the thickness of the bladder walls. A bladder wall measuring more than three millimeters when inflamed and greater than five millimeters when normal is thought to be trabeculated. The diagnosis can be made by -
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Thorough physical examination.
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Ultrasound imaging.
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Bladder Catheterization - Bladder catheterization is a diagnostic procedure in which a silicone or latex tube is passed into the bladder through the urethral opening to remove the urine stored in the bladder.
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Urine Test - This is done to find out certain components that might be present in the urine.
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Blood Test - This is carried out to evaluate how well the kidneys are working.
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Prostate-specific antigen (PSA) test for men with an enlarged prostate.
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Rectal examination.
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Endoscopy - A long, thin, flexible tube with a tiny camera attached at one end, known as an endoscope, is inserted inside the body through the urethra to examine the urethra, prostate, and bladder.
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Voiding Cystourethrography - This diagnostic test is done to see the person’s urethra and bladder size during urination.
How Is Bladder Trabeculation Classified?
Bladder trabeculation has been divided into four grades according to the depth and the part of the bladder surface involved.
Grade 0 - No extent of bladder trabeculations.
Grade 1 - Mild, depth less than 5 mm (millimeters), and area less than half of the bladder.
Grade 2 - Moderate, depth of 5 to 10 mm and area greater than or equal to half of the bladder.
Grade 3 - Severe, depth greater than 10 mm and an area greater than or equal to half of the bladder.
How Is Bladder Trabeculation Treated?
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Bladder trabeculation is treated by treating the underlying cause. Bladder trabeculation is a symptom of a blockage. Removal of the blockage is the aim of the treatment to prevent the condition from complicating further. In the case of an enlarged prostate, treating the prostate with medications and surgery to reduce its size is recommended.
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The doctor might recommend medications or other suitable medical procedures to treat the obstruction to treat obstructions due to tumors, kidney stones, or a different urethral blockage. For example, smaller kidney stones can pass independently with increased fluid uptake. In the case of larger stones, ultrasound shock waves are used to break down the stones into smaller pieces that can be passed out of the body via urine. In the case of malignant tumors, treatment with radiotherapy and chemotherapy is done to treat the tumor.
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In case the blockage is due to pregnancy, no treatment is required. Post delivery, the bladder might return to its original size.
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In the case of an enlarged prostate, treatment can be done with the help of medications, minimally invasive therapies, or surgery. The severity of the condition, the presence of certain medical conditions, overall health, and age determine the treatment plan.
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If a fetus has a urethral obstruction, an intrauterine surgery might be done to rectify it.
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Proper diagnosis and treatment of the underlying cause of bladder tuberculation are essential to prevent the development of complications. The bladder wall elasticity, once lost, is difficult to regain.
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The success of the treatment largely depends on the early diagnosis.
How Is the Outlook of Bladder Trabeculation Treatment?
Once the bladder wall elasticity is lost, it becomes challenging to regain the elasticity. In case the condition is diagnosed early, it can be treated within time, thus preventing it from getting any further. A severe reduction in the bladder wall elasticity can mean that the bladder holds on to the urine for a long time, which can lead to kidney damage. Kidney damage could need dialysis or a kidney transplant.
Conclusion:
Bladder trabeculation is when the muscles of the urinary bladder wall become hard. Repeated urethral blockages from an enlarged prostate, polyps, pregnancy, or pelvic organ prolapse can cause the condition. Diagnosis is made by various tests such as blood, urine, and imaging tests. Treatment is based on the underlying cause of the blockage. In case of any difficulty in urination, one must visit the doctor for their advice. Early diagnosis and treatment are critical factors preventing the condition from worsening further.
