Bladder diverticulum – meshkovidny deepening in a bladder wall which is reported with the main cavity by means of the channel – a diverticulum neck. The diverticulum of a bladder is shown by the complicated urination which is carried out in two steps; can be complicated by development of cystitis, urolithic disease, pyelonephritis. The diverticulum is distinguished when performing ultrasonography of a bladder, a viewing tsistoskopiya, tsistografiya, tomographic researches. Treatment of diverticulums of a bladder consists in performance of a divertikulektomiya.
The diverticulum represents a bladder wall prolapse with formation of an additional pathological meshkovidny cavity. The cavity of a diverticulum is reported with a bladder by means of the neck connecting them. Existence of a diverticulum promotes stagnation of urine and, as a result, development of inflammatory urological diseases (cystitis, pyelonephritises), formation of concrements in a bladder (an urolithic disease), to development of a gidronefroz.
Usually the diverticulum is formed in the field of back and sidewalls of a bladder, near the mouth of a mochetochnik; more rare - in the field of a bottom or a top of a bladder. The diverticulum can be small or have the sizes surpassing bladder volume. At men diverticulums of a bladder develop in 15 times more often than at women that is connected with prostate diseases.
Classification of diverticulums of a bladder
On an etiology and time of development diverticulums of a bladder are subdivided on congenital (primary) and acquired (secondary). The clinical urology faces the acquired bladder diverticulums more often. Depending on the number of additional cavities diverticulums can be single and multiple. At multiple diverticulums pathology is regarded as a bladder.
On the structure diverticulums of a bladder happen true and false. In case of a true diverticulum its wall is presented by the same layers, as a bladder wall (a mucous membrane, a submucous basis, muscular and external adventitsialny covers). At a false diverticulum the wall is formed only by a mucous layer of a bladder which, like hernia, is stuck out through detruzor fibers. The acquired bladder diverticulums, as a rule, are false, and congenital – true.
Reasons of formation of diverticulums of a bladder
Congenital the diverticulum is formed as a result of dizembriogenetichesky anomaly of development of a wall of a bladder – weakness of a detruzor.
The acquired diverticulum of a bladder develops owing to long increase in vnutripuzyrny pressure, restretching of a wall and a divergence of fibers of a muscular layer. Such state is most often caused by infravezikalny obstruction at prostate gland adenoma, an urethra striktura, a bladder neck sclerosis, etc. the reasons interfering free outflow of urine. Need of a natuzhivaniye at an urination leads to gradual weakening and stretching of a wall of a bladder, i.e. formation of a diverticulum.
Bladder diverticulum symptoms
The small single diverticulum of a bladder can not cause any symptomatology. Clinically significant the diverticulum becomes at increase in the sizes when it serves as an obstacle for full depletion of a bladder. As the leading manifestations of a diverticulum serve dizurichesky frustration and .
At a diverticulum the patient cannot empty a bladder in one stage: the urination occurs in two steps – at first urine flows from a bladder, and then from a diverticulum cavity. Duration of the act of an urination at the same time also increases; the gematuriya, a terminal piuriya (at the end of an urination pus is emitted) can be noted, sometimes there is a full delay of urine.
Stagnation of urine in a diverticulum leads to accession of a secondary infection and development persistent, not giving in to therapy, cystitis and a divertikulit, to formation of concrements or tumors. In case the mouth of a mochetochnik opens in a diverticulum cavity, the puzyrno-mochetochnikovy reflux develops that is fraught with developing of pyelonephritis, a gidronefroz and a renal failure.
Diagnostics of a diverticulum of a bladder
Detection of a diverticulum of a bladder often happens during inspection of the patient concerning frequent recurrent cystitis and pyelonephritises. The main methods of diagnostics of a diverticulum are ultrasonography of a bladder, the tsistoskopiya and a tsistografiya.
In the course of a tsistografiya the bladder is filled with X-ray contrast substance, then a series of pictures is carried out. At depletion of a bladder contrast is late in a diverticulum in this connection its shadow looks more dense in comparison with a bubble cavity shadow. The diverticulum shadow usually is defined in a side or slanting projection.
Carrying out a tsistoskopiya allows to reveal the isthmus connecting a bladder to a diverticulum. If the cystoscope manages to be entered into a diverticulum cavity, then it is possible to define existence of a puzyrno-mochetochnikovy reflux and additional new growths, diverticulum type (false, true).
Ekhografiya (ultrasonography) of a bladder promotes assessment of an arrangement, size, a form of a diverticulum, the sizes of his neck, allows to judge spatial relationship with surrounding structures, existence of tumors, stones. At identification of a diverticulum of a bladder for definition of infravezikalny obstruction carrying out urodinamichesky researches - urofloumetriya, tsistometriya, etc. is obligatory.
Treatment of a diverticulum of a bladder
The diverticulum of a bladder of the small size which is not causing the dizurichesky phenomena and recidivous inflammations can be left under dynamic observation of the urologist. When determining availability of residual urine, concrements, tumors, the considerable size of a diverticulum, clinic of a sdavleniye of the next bodies the operational grant is applied. Surgeries at a diverticulum of a bladder can be carried out by endoscopic or open access.
Resort to endoscopic (transurethral) operations for performance of plasticity of a neck of a true diverticulum: the section of the channel of a pathological cavity is made and the adequate message of a diverticulum with a bladder is created. The thicket in urological practice needs performance of open operation – a divertikulektomiya – full excision of a diverticulum. Operation is carried out through a nadlobkovy section. After allocation of a bladder open its forward wall, define finding of a diverticulum and cut it at the place of falling into a bladder. The wound is layer-by-layer sewn up and drained. In the post-operational period the long kateterization of a bladder is carried out.
In the presence of the mochetochnik opening in a diverticulum his change in a bladder wall is made – formed uretero-tsistoneoanastomoz. At the false (acquired) diverticulums surgical elimination of the reason of infravezikalny obstruction is required.
Prevention and the forecast at bladder diverticulums
Prevention of formation of the acquired diverticulums of a bladder demands timely elimination of the reasons promoting developing of pathology (a giperplaziya of a prostate, a bladder neck sclerosis, urethras, etc.).
Surgical treatment of a diverticulum of a bladder yields good results and allows to avoid development of an urolithic disease, recurrent pyelonephritis, cystitis, a divertikulit, an urolithic disease, a gidronefroz and a renal failure.