Primary Congenital Bladder Diverticulum - Causes, Diagnosis, and Treatment

What Is Primary Congenital Bladder Diverticulum?

The bladder diverticulum occurs when the bladder muscles become weak, leading to the pouching or bulging of the bladder wall. This condition is present by birth and is known as a congenital bladder diverticulum. It mainly occurs when the bladder wall becomes weak, and a part of the bladder lining protrudes. It is commonly seen in children, mainly in a single pouch, so the condition might not require any treatment. If the situation is not present by birth, it is known as acquired bladder diverticula. A block mainly causes it in the bladder outlet that mainly occurs due to swelling in the prostate gland and scars in the urethra. This condition is commonly seen in elderly males who tend to get more bladder outlet blocks and form pouches.

What Is a Urinary Bladder?

The urinary system is a crucial organ system of the body. It comprises organs that form urine, filter the waste products from the body and maintain the fluid and electrolyte levels of the body. The urinary bladder is an integral part of the urinary system. It is a balloon-like structure that temporarily holds the urine and helps the person pass urine. The urinary bladder consists of muscles that contract and relax rhythmically to transport urine to the urethra. The urethra is a tube-like structure that connects the bladder to the outside world and helps the person urinate.

What Are the Causes of Bladder Diverticulum?

Several factors are responsible for bladder diverticulum. These factors are listed below:

• Hutch Diverticula - It is a condition in which outward bulges are seen at the junction of the ureters and the bladder. This condition mainly occurs due to a defect in the urinary bladder muscles and is only seen in males.

• Bladder Neck Problems - The area between the urinary bladder and the urethra is known as the bladder neck. This condition mainly affects the bladder muscles and is commonly seen in males.

• Neurogenic Bladder - It is a condition in which bladder muscles become weak due to damage to the nerves that connect the bladder and the brain. It is commonly seen in elderly males above 50 years of age.

• Enlargement of the Prostate Gland -The prostate gland is located near the neck of the urinary bladder. When the prostate gland enlarges, it presses on the bladder wall, weakening the bladder muscle.

• Ureterocele - It is a condition where the lower end of the ureter bulges out to the extent that it enters the bladder.

• Ehlers-Danlos Syndrome - It is a rare hereditary condition that mainly affects the connective tissues that support the tendons, skin, bones, and internal organs.

• Menkes Syndrome - This condition mainly occurs due to the deficiency of copper in the body. As a result, the urinary bladder muscles become weak, and the wall tends to bulge outward.

What Are the Signs and Symptoms of Primary Congenital Bladder Diverticulum?

The patient does not present any symptoms of bladder diverticulum in most cases. However, it is incidentally detected when the doctor suspects urinary symptoms in children and adults. The signs and symptoms of bladder diverticulum are listed below:

1. Recurrent urinary tract infections.

2. Pain and fullness in the lower abdomen.

3. Discomfort.

4. Difficulty in urinating.

5. Blood in the urine.

6. Fever.

7. Inflammation of the diverticulum.

8. Vesicoureteral reflux (a condition in which the urine flows back to the kidneys instead of flowing outside the body).

9. Tumors and stones in the urinary bladder.

How Is Primary Congenital Bladder Diverticulum Diagnosed?

A bladder diverticulum is challenging to diagnose as the symptoms resemble many other urologic conditions. It might be incidentally discovered during imaging tests. The diagnostic methods for bladder diverticulum are listed below:

• Cystoscopy - Cystoscopy allows the doctor to view the urinary tract organs with the help of a special camera known as the cystoscope. In this procedure, a tube known as a cystoscope is inserted to examine the walls of the bladder and urethra. It is a diagnostic and therapeutic tool to address the problems of the urinary system.

• Urodynamic Study - Urodynamic study is done to check whether the organs comprising the lower urinary tract, the urethra, and the urinary bladder work to store and release the urine or not. The test aims to check whether the bladder can hold or empty urine.

• X-rays (Conventional Radiology): X-rays of the urinary system help detect the presence of a tumor or stone that obstructs urine flow. The patient presents with pain if the urine does not flow freely. Another cause of restricted urine flow in men is the enlargement of the prostate gland, which is located near the urethra. X-rays show the prostate gland clearly and help determine the size of the gland.

How Is Primary Congenital Bladder Diverticulum Treated?

Patients suffering from bladder diverticulum do not always require any treatment. However, the treatment is done to manage the underlying cause. The treatment for primary congenital bladder diverticulum has been summarized in the points given below:

• People suffering from bladder diverticulum due to a blockage in the bladder can be treated by removing the cause of obstruction or blockage. Mostly, the doctor will obtain samples of the abnormal growth found in the diverticulum and test it microscopically to detect cancer.

• The patient might require open or laparoscopic surgery depending upon the cause of the condition. Sometimes, the diverticula might be removed during the cystoscopy procedure.

• If the patient cannot undergo open surgery, the diverticulum can be managed by widening its opening into the cavity of the bladder.

• The treatment is usually effective only if the condition is treated and does not recur. Periodic monitoring must be done to look for the recurrence of the condition.

• Some patients might have poor bladder function due to long-term obstruction. Therefore, these patients might require intermittent catheterization (a procedure where a flimsy tube called a catheter is inserted to remove the urine from the body) to empty the bladder.

What Are the Risks of Bladder Diverticulum Surgery?

The treatment for bladder diverticulum often works and helps ease the symptoms. However, if the cause of bladder diverticulum is treated, the patient need not be treated further. The catheter will remain in place after the surgery for one or two weeks. The risks of diverticulum surgery are:

• Damage to the ureters and intestines.

• Leakage of urine from the urinary bladder.

• Infections.

Conclusion:

Bladder diverticulum surgery aims to treat people suffering from urinary obstruction due to outpouching or bulging of the bladder wall. It is a boon for the ones suffering from urinary tract infections and other diseases due to bladder diverticulum. So the patient must notice the symptoms of urinary obstruction due to bladder diverticulum and consult their doctor at the earliest to know more about the surgical procedure to prevent complications and improve their living condition.