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Giant Urinary Bladder Diverticula presenting as Epigastric Mass and Dyspepsia.

Kumar S, Jayant K, Barapatra Y, Rani J, Agrawal S - Nephrourol Mon (2014)

Bottom Line: Patient was discharged in satisfactory condition.Although presentation of bladder diverticulum is nonspecific, its effect on renal system is significant.Therefore, awareness of patients and physicians is necessary to prevent its consequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT

Introduction: Bladder diverticulum is a result of bladder mucosa and submucosa herniation through the muscularis propria of bladder wall. Bladder diverticula are mostly seen in the elderly men in association with benign prostatic hyperplasia (BPH).

Case presentation: A 74-year-old man presented with complaints of vague epigastric discomfort, dyspepsia, and mild lower urinary tract symptoms. An ultrasonography of the abdomen showed bilateral hydroureteronephrosis, large cystic lesion with the size of 26.3 × 20.5 cm and in continuation of urinary bladder and prostate of 70 mL volume. Voiding cystourethrogram revealed a large diverticulum with its neck communicating with bladder on posterior aspect. Abdominopelvic contrast-enhanced computed tomography revealed bilateral hydronephrosis with large bladder diverticulum of 27.3 × 21.5 cm in size with smooth diverticular wall. On cystoscopy, the neck of diverticulum was seen at the posterior wall of bladder. Open prostatectomy and diverticulectomy were done simultaneously (Figure 3). Postoperative course was uneventful. The histopathological assessment showed features of chronic inflammation without any evidence of malignancy. On the third postoperative day, the urethral catheter was removed and suprapubic catheter was clamped. Patient was voiding well and cystography done on day 12 revealed smooth bladder contour without any leakage; hence, suprapubic catheter was removed. Patient was discharged in satisfactory condition.

Conclusions: The elderly men are at high risk of developing bladder diverticulum, which may be due to high prevalence BPH in this group. Although presentation of bladder diverticulum is nonspecific, its effect on renal system is significant. Therefore, awareness of patients and physicians is necessary to prevent its consequences.

No MeSH data available.


Related in: MedlinePlus

Contrast-Enhanced Computed Tomography of Abdomen Showing Giant Urinary Bladder Diverticulum
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fig12137: Contrast-Enhanced Computed Tomography of Abdomen Showing Giant Urinary Bladder Diverticulum

Mentions: A 74-year-old man presented to the outpatient department of our institute with complaints of dyspepsia, fullness in the central abdomen extending from epigastrium to umbilicus, and mild lower urinary tract symptoms such as dysuria, increased urinary frequency, nocturia, and diminished urinary stream for the preceding two years (Figure 1). On physical examination, there was a palpable lump in the upper abdomen extending from the epigastrium to the pubic symphysis, which was nontender, firm in consistency with indistinct lower border. A urethral catheter was placed immediately and 2000 mL of urine was drained that led into improvement of abdominal distension and discomfort. His initial investigation revealed hemoglobin of 11 g/dL, TLC (Total Leukocyte Count) of 11000/µL, serum urea of 66 mg/dL, serum creatinine of 2.1 mg/dL, and serum PSA of 2.4 ng/mL. The ultrasonography of the abdomen showed bilateral hydroureteronephrosis and a large cystic lesion of 26.3 × 20.5 cm size in continuation of urinary bladder. Voiding cystourethrogram revealed a large diverticulum with its neck communicating with posterior wall of bladder. Abdominopelvic contrast-enhanced computed tomography revealed bilateral hydronephrosis with large bladder diverticulum with 27.3 × 21.5 cm size and smooth diverticular wall (Figure 2). Cystoscopy revealed diffuse trabeculation inside the urinary bladder. The neck of diverticulum was seen on the posterior wall of bladder. The inner aspect of diverticulum was smooth and biopsy showed features of inflammation without any evidence of malignancy. Open prostatectomy and diverticulectomy through a midline incision were done simultaneously (Figure 3). Postoperative course was uneventful. The histopathological assessment of the specimen revealed that the wall diverticulum was composed of mucosa and lamina propria with scattered thin muscle fibers with features of chronic inflammation without any evidence of malignancy. On day 12, follow-up cystography showed smooth bladder contour without leakage. Hence, the suprapubic catheter was removed. Uroflowmetry showed a peak flow rate of 11 mL/s on voiding 256 mL urine, with 15 mL residual urine and improved serum creatinine of 1.7 mg/dL and serum urea of 40 mg/dL. Patient was discharged in satisfactory condition and was doing well on follow-up.


Giant Urinary Bladder Diverticula presenting as Epigastric Mass and Dyspepsia.

Kumar S, Jayant K, Barapatra Y, Rani J, Agrawal S - Nephrourol Mon (2014)

Contrast-Enhanced Computed Tomography of Abdomen Showing Giant Urinary Bladder Diverticulum
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4317721&req=5

fig12137: Contrast-Enhanced Computed Tomography of Abdomen Showing Giant Urinary Bladder Diverticulum
Mentions: A 74-year-old man presented to the outpatient department of our institute with complaints of dyspepsia, fullness in the central abdomen extending from epigastrium to umbilicus, and mild lower urinary tract symptoms such as dysuria, increased urinary frequency, nocturia, and diminished urinary stream for the preceding two years (Figure 1). On physical examination, there was a palpable lump in the upper abdomen extending from the epigastrium to the pubic symphysis, which was nontender, firm in consistency with indistinct lower border. A urethral catheter was placed immediately and 2000 mL of urine was drained that led into improvement of abdominal distension and discomfort. His initial investigation revealed hemoglobin of 11 g/dL, TLC (Total Leukocyte Count) of 11000/µL, serum urea of 66 mg/dL, serum creatinine of 2.1 mg/dL, and serum PSA of 2.4 ng/mL. The ultrasonography of the abdomen showed bilateral hydroureteronephrosis and a large cystic lesion of 26.3 × 20.5 cm size in continuation of urinary bladder. Voiding cystourethrogram revealed a large diverticulum with its neck communicating with posterior wall of bladder. Abdominopelvic contrast-enhanced computed tomography revealed bilateral hydronephrosis with large bladder diverticulum with 27.3 × 21.5 cm size and smooth diverticular wall (Figure 2). Cystoscopy revealed diffuse trabeculation inside the urinary bladder. The neck of diverticulum was seen on the posterior wall of bladder. The inner aspect of diverticulum was smooth and biopsy showed features of inflammation without any evidence of malignancy. Open prostatectomy and diverticulectomy through a midline incision were done simultaneously (Figure 3). Postoperative course was uneventful. The histopathological assessment of the specimen revealed that the wall diverticulum was composed of mucosa and lamina propria with scattered thin muscle fibers with features of chronic inflammation without any evidence of malignancy. On day 12, follow-up cystography showed smooth bladder contour without leakage. Hence, the suprapubic catheter was removed. Uroflowmetry showed a peak flow rate of 11 mL/s on voiding 256 mL urine, with 15 mL residual urine and improved serum creatinine of 1.7 mg/dL and serum urea of 40 mg/dL. Patient was discharged in satisfactory condition and was doing well on follow-up.

Bottom Line: Patient was discharged in satisfactory condition.Although presentation of bladder diverticulum is nonspecific, its effect on renal system is significant.Therefore, awareness of patients and physicians is necessary to prevent its consequences.

View Article: PubMed Central - PubMed

Affiliation: Department of Urology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

ABSTRACT

Introduction: Bladder diverticulum is a result of bladder mucosa and submucosa herniation through the muscularis propria of bladder wall. Bladder diverticula are mostly seen in the elderly men in association with benign prostatic hyperplasia (BPH).

Case presentation: A 74-year-old man presented with complaints of vague epigastric discomfort, dyspepsia, and mild lower urinary tract symptoms. An ultrasonography of the abdomen showed bilateral hydroureteronephrosis, large cystic lesion with the size of 26.3 × 20.5 cm and in continuation of urinary bladder and prostate of 70 mL volume. Voiding cystourethrogram revealed a large diverticulum with its neck communicating with bladder on posterior aspect. Abdominopelvic contrast-enhanced computed tomography revealed bilateral hydronephrosis with large bladder diverticulum of 27.3 × 21.5 cm in size with smooth diverticular wall. On cystoscopy, the neck of diverticulum was seen at the posterior wall of bladder. Open prostatectomy and diverticulectomy were done simultaneously (Figure 3). Postoperative course was uneventful. The histopathological assessment showed features of chronic inflammation without any evidence of malignancy. On the third postoperative day, the urethral catheter was removed and suprapubic catheter was clamped. Patient was voiding well and cystography done on day 12 revealed smooth bladder contour without any leakage; hence, suprapubic catheter was removed. Patient was discharged in satisfactory condition.

Conclusions: The elderly men are at high risk of developing bladder diverticulum, which may be due to high prevalence BPH in this group. Although presentation of bladder diverticulum is nonspecific, its effect on renal system is significant. Therefore, awareness of patients and physicians is necessary to prevent its consequences.

No MeSH data available.


Related in: MedlinePlus