Diagnosis of Bladder Diverticula with Point-of-Care Ultrasound

Case Presentation: A 65-year-old male presented to the emergency department with symptoms including fever, abnormal urinalysis, and elevated post-void residual. Point-of-care ultrasound was used to rapidly diagnose a bladder diverticulum. The patient was subsequently seen by urology for outpatient bladder repair. Discussion: Bladder diverticula, an out-pouching of the bladder, may occur congenitally or as a result of various bladder conditions and/or surgery. Although bladder diverticula are rare and often asymptomatic, severe complications including frequent recurring urinary tract infections may arise depending on the patient.

Tubular Dysfunction and Ruptured Ureter in a Child with Menkes Syndrome

Children with Menkes disease may develop various urological and renal problems that evolve as the disease progresses. A 4-year-old boy with Menkes disease had multiple bladder diverticula and a history of recurrent urinary tract infection caused by urea-splitting organisms. The child developed urosepsis and right pyelonephritis. Subsequent investigations revealed multiple right renal stones and a ruptured right ureter. The child also developed hypokalemia, hypophosphatemia, and normal anion gap metabolic acidosis that required electrolyte and potassium citrate supplement. Further assessment revealed renal tubular dysfunction. Our case suggests that regular imaging surveillance, monitoring of renal function and electrolyte profile, and tubular function assessment should be considered in children with Menkes disease.

Large congenital bladder diverticula in children

Objective: Large congenital bladder diverticula (LCBD), congenital bladder diverticula (CBD) larger than 2 cm diameter, is a rare anomaly. The aim of this study was to report long-term surgical and clinical outcomes of children with LCBD. Methods: Medical charts of all children who were diagnosed with LCBD at our institution between April 2005 and December 2017, with at least 2 year follow-up were retrospectively reviewed. Patients’ demographics, symptoms, operative technique, diverticulum size and localization, surgical outcomes and complications were recorded. Results: Fourteen patients with 18 LCBD, all male and age between 7 and 240 months (mean age: 53.5 months) were included in the study. Urinary tract infection was the main complaint in 10. Vesicoureteral reflux was detected in eight patients. Diverticula were 2–5.5 cm (mean 3.3 cm) in size. All diverticulectomies were performed transvesically and ureteroneocystostomy was added in 12 patients, 5 of whom were bilateral. No postoperative infection or recurrent reflux were observed. The median follow-up period was 4.5 years (2–12 years). Conclusion: Treatment of LCBD is mostly surgical and transvesical approach for diverticulectomy was found to be a safe and effective surgical procedure in long term follow-up.

SPECTRUM OF BLADDER DIVERTICULI PRESENTING WITH UNUSUAL SYMPTOMS: A CASE SERIES STUDY

Diverticula of the urinary bladder can occasionally appear as complex pelvic masses not obviously connected to the bladder. Such presentations can lead to diagnostic confusion and interpretative error. Sonographic ndings and clinical histories were reviewed in 10 patients in whom bladder diverticula were initially mistaken for other types of pathologic pelvic processes. Sonographic techniques that were helpful in elucidating the true nature of the lesions included scanning from different perspectives with increasing increments of bladder distension, post void images, colour Doppler interrogation and Valsalva manoeuvre. The sonographic ndings were correlated with micturating cystourethrogram and CT nding. The diagnosis of bladder diverticula should be considered and actively pursued when sonologists are confronted with pelvic masses of ambiguous origin.

A RARE CAUSE OF URINARY TRACT INFECTION IN PAEDIATRIC POPULATION

Primary congenital bladder diverticulum is a rare cause of Urinary Tract Infection (UTI). The term bladder diverticulum is usually reserved for the nding of large herniation of bladder urothelium through muscularis propria of the bladder wall. Typically, congenital bladder diverticula are found in smooth walled bladders and are not associated with signicant trabeculation on cystoscopic examination.Congenital bladder diverticula have been noted in association with a number of congenital syndromes including Menkes syndrome, Williams syndrome, Ehler-Danlos syndrome and fetal alcohol syndrome.We present a case of Primary congenital bladder diverticulum as a rare cause of UTI in a 4year old male child who was surgically treated.

Robotic Simple Prostatectomy: Why and How?

Increasingly many studies have presented robotic simple prostatectomy (RSP) as a surgical treatment option for large benign prostatic hyperplasia (BPH) weighing 80–100 g or more. In this review, some frequently used RSP techniques are described, along with an analysis of the literature on the efficacy and complications of RSP and differences in treatment results compared with other surgical methods. RSP has the advantage of a short learning curve for surgeons with experience in robotic surgery. Severe complications are rare in patients who undergo RSP, and RSP facilitates the simultaneous treatment of important comorbid diseases such as bladder stones and bladder diverticula. In conclusion, RSP can be recommended as a safe and effective minimally invasive treatment for large BPH.

The Feasibility, Technique, and Medium-Term Follow-Up of Laparoscopic Transvesical Diverticulectomy

<b><i>Background:</i></b> To present our experience and results with the transvesical laparoscopic diverticulectomy, developed by Pansadoro et al. [<i>BJU Int</i>. 2009;103(3):412–24], as treatment of symptomatic bladder diverticula, with a medium-term follow-up. <b><i>Methods:</i></b> Between June 2010 and July 2018, we successfully operated 15 patients (13 male/2 female), aged 32–85 years (mean age 61 years) in 2 centers in Austria, using the aforementioned technique. <b><i>Results:</i></b> The median operative time was 297 min (range 83–488 min), and the blood loss was minimal. The median diameter of the diverticula was 94 mm (range 40–110 mm). The transurethral catheter was removed in most patients on day 7 (range 1–26 days), and cystography was performed before catheter removal. Patients were discharged on the ninth postoperative day (range 4–18 days). One case had a Clavien-Dindo grade IIIb complication (ureter injury), and 2 cases had a grade IIIa complication (nephrostomy drainage). After a median follow-up of 19 months, no recurrences were observed. <b><i>Conclusion:</i></b> The laparoscopic, transvesical diverticulectomy is a feasible and valuable procedure with good outcomes. To avoid complications, the ureter needs to be spared meticulously.