Diagnosis and treatment of bladder diverticulum

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1. What causes bladder diverticulum?

Herniation of the lining of the bladder through the bladder muscle will lead to the formation of a bladder diverticulum. Most of the patients with bladder diverticulum are located at the back of the bladder.
Bladder diverticulum is either congenital or acquired.
Congenital causes often occur during bladder formation in children, bladder diverticulum will usually be located near the insertion of the ureter. Because the ureter is too compressed by the diverticulum, it will affect the ureter, causing vesicoureteral reflux or ureteral aneurysm. Acquired causes mostly occur in adults. Initially the bladder is completely normal, then there is a blockage of the outflow tract, which increases the pressure on the bladder. This leads to the formation of a bladder diverticulum.

2. Local complications of bladder diverticulum

Bladder diverticulum wall has only mucosal layer and serosa layer without muscle layers, moreover the diverticulum neck is very narrow. That's why urine is always stuck in this diverticulum. Over time, it will lead to complications such as:
Chronic stasis Urinary tract infection Bladder stones Pain in the pelvic region Acute or chronic urinary retention Urinary disorders Bladder tumor

3. Diagnosis of bladder diverticulum

There are many methods to diagnose bladder diverticulum and can be used for both men and women.
3.1 Physical examination Physical examination is a very common method of examination of the urinary system. Physical examination is when the doctor will look, feel, and tap to detect abnormalities in the patient's urinary system. Based on the clinical symptoms, the doctor can assign the patient to do more tests such as: Blood test, urine or cell biopsy ... to finally give the most accurate diagnosis.
For a female patient with a bladder diverticulum, the doctor may examine the vaginal wall to detect underlying masses. Not only that, but the doctor can also find a way to remove any pus or urine from the inside of the diverticulum with this method.

3.2 Ultrasound Ultrasound is a very popular diagnostic imaging technique. Thanks to the pelvic ultrasound, the doctor can easily see the patient's bladder diverticulum if present.
3.3 Cystoscopy Cystoscopy is also used a lot in the diagnosis and treatment of urinary diseases for patients. With this method, the endoscope will be inserted into the patient's bladder through the urethra.
The doctor can easily monitor through the endoscope screen or look directly through the endoscope to check the patient has a bladder diverticulum or not. With this method, the doctor can also take a small tissue sample of the bladder lining for biopsy, thereby diagnosing urinary tract diseases.
3.4 Magnetic resonance imaging (MRI), X-ray of bladder and urinary tract during urination MRI is considered the best diagnostic method for bladder diverticulum in both men and women. Besides, bladder X-ray is also quite good method to diagnose bladder diverticulum.
3.5 Double Balloon Positive Pressure Urethrography This method is somewhat similar to the X-ray of the bladder and urinary tract as above. However, this method uses a special catheter to diagnose urethral diverticulum with an accuracy rate of 90%.
But this method is an invasive diagnosis, so it makes the patient very uncomfortable and requires anesthesia. Therefore, it is not used much and is not a first-line diagnostic tool of choice.

4. Bladder diverticulum treatment

To treat bladder diverticulum, doctors have quite a few methods that patients can choose from.
Complete excision of the bladder diverticulum Cut into the neck of the bag and then drain the contents Using the Spence procedure, opening the path from the diverticulum to the vagina Surgery to treat bladder diverticula can be done with open surgery , complete resection of the external or intravesical diverticulum. The doctor may also combine bladder opening and closing the neck of the diverticulum after resection.
If the diverticulum is primary and affects the ureter, then surgery combined with re-implantation of the ureter is required. If the diverticulum is small, the doctor may perform a cystoscopy and make a wide incision in the neck of the diverticulum.
If the diverticulum is secondary, the cause of the lower urinary tract obstruction must be removed and bladder pressure relieved.
Depending on the patient's case, the doctor will have a surgical plan indicated. After surgery, the patient is given some type of antibiotic for at least 24 hours and may have a catheter inserted, which holds the urethra in place for several weeks. Depending on the patient's recovery status, the catheter will be removed.
Any surgery can have complications or some side effects. With surgery to treat bladder diverticulum, the possible side effects are heavy bleeding, recurrent diverticulum, infection, urethral scarring, urethral fistula. Patients should have a thorough discussion with their doctor before deciding to have surgery.

Currently, laser vaporization endoscopic technique is being deployed in hospitals of Vinmec Health System. The C-Arm system, the intraoperative ultrasound machine helps to clearly locate the bladder diverticulum size to help the surgeon monitor the bladder condition during and after surgery, limiting intra- and postoperative complications.
The most modern Hybrid operating room in the world, integrating the operating room and advanced imaging facilities (CT scan, MRI, ultrasound...) helps to reduce surgery time and bring effective surgery. best technique for the patient.
In general anesthesia, Vinmec adheres to anesthesia protocols, anesthesia safety guidelines, anesthesia checklists for 100% of surgeries to minimize incidents and unwanted effects. In addition, patients receive comprehensive care, meals, rest, exercise, thoughtful health education, comfortable rooms, and confidential patient information.
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