BLADDER DIVERTICULUM IN WOMEN

The bladder diverticulum is rarely encountered in women. But it is common in men (90%).

The urology department of Khmer-Soviet Friendship Hospital, we encountered two cases of bladder diverticula in women: a case in 2006 and another case in 2011.

Clinic cases

          Case 1

Pattern entered

Mrs. S.P, 68 years old, living in Kien Svay, Kandal Province entered our urology department on 13.11.2006 for urinary retention  with hypogastric arch.

History of the disease

For three months, she presented with voiding disorder type of urinary frequency, dysuria with sensation of postvoid residual urine and incontinence of urine when standing or sitting.

Antecedent

– Episode of micturition disorder (urinary frequency, dysuria)

– No concept of maneuver to the instrumental intraurethral.

Clinical signs

– Hypogatric arch

– Dysuria, urinary frequency

– Dull pain hypogastric

– Sensation of residual urine post-voiding

– Incontinence of urine when standing or sitting.

Physical examination

– Globe bladder

– Urethral meatus: normal

– The catheterization is impossible because of urethral strictures.

Paraclinical

• Ultrasound:

– The bladder is distended with thickened wall (thickness = 6mm)

– A diverticulum 2.7 cm diameter to the right side wall of the bladder.

• IVU 

Renal function : nornale

             • Retrograde Cystography

Front  view

Profile view

Treatment

Intravesical diverticulectomy

Postoperative recoverie

            – The urine tube is a little red on the first day and is becoming increasingly clear in the                               following  days.

            – Drainage prevesicale is removed to the 3rd day.

            – The bladder catheter is removed to the 8th day.

            – The micturition is normal

            – The wound is well healed to the 10th day.

Cystography  control

Before the operation

After the operation

 Case 2

Pattern entered

Mrs. A.I, 56 years old residing in Trapeang Snuorl, Srok Syay Sa, Pursat Province, entered our Urology Department on 25.03.2011 for urinary retention with indwelling bladder catheter.

History of the disease

            She was hospitalized at the Hospital of Province for a week for urine retention. We indwelt the bladder catheterization. After removing the catheter, the micturition is normal.

One day after, she presented again retention of urine and it was still indwelling catheterization. Finally she transferred to the urology department of Khmer-Soviet Friendship Hospital.

Antecedent

– Episode of micturition disorder: urinary frequency, dysuria, burning micturition

– No concept of maneuver to the instrumental intraurethral.

Clinical

            • Clinical signs

– Bladder catheter indwelling

– Urine cloudy yellow

– Dull pain in the suprapubic region

             • Ultrasound

 

      It shows a diverticulum in the posterior-right side.

              • IVU

 

      Renal function: normal

               • Cystography

Treatment

             Diverticulectomy through mixed endo and exovesicale breaching the peritoneum.

 Postoperative recoveries

            – The urine tube is a little red on the first day and is becoming increasingly clear in the following      days.

            – Drainage and pre-vesicals Douglas are removed to the third day

            – A urinary catheter is removed to the 10th day

            – The wound is well healed to the 10th day

            – Urinary frequency and burning micturition was observed after removing the catheter.

Cystography control

Before the operation

  After the operation

Conclusion

 

            • The bladder diverticula are primarily the consequence of an obstruction under the bladder.

            • Correcting the underlying obstructive cause can prevent new diverticular formations.