Diverticulum of the bladder. Diverticulosis.- Causes, symptoms and treatment. MF.

The diverticulum of the bladder is the protrusion of the organ wall into a bag-like reservoir in which urine accumulates. Multiple formation of diverticula in the wall of the bladder is called diverticulosis.

Causes of bladder diverticula

In origin, bladder diverticulums can be congenital and acquired. Congenital diverticula are called true because their wall consists of all layers of the bladder. The causes of their occurrence can be different chromosomal pathologies, the clinical picture of which is characterized by multiple developmental defects, including the organs of the genitourinary system.

Acquired diverticula are called false, since their wall differs from the wall of the bladder by the absence of a muscle layer. The cause of false diverticula is the pressure in the bladder, which increases with a delay in urine. This can occur with diseases such as prostate adenoma, prostate cancer or urolithiasis. The mechanism of development of the acquired diverticulum is that when the urine retention compensatory develops hypertrophy of the muscular wall of the bladder. Further in one place the muscular wall begins to thin out, which leads to a divergence of the muscle fibers and protrusion of the bladder lumen in the form of a sac.

In addition, acquired bladder diverticula may be a consequence of the trauma of this organ. The most common cause of this pathology is a blunt trauma of the bladder, in which there is no violation of the integrity of its lumen.

Symptoms of bladder diverticula

As a rule, the presence of diverticula of the bladder is not accompanied by vivid clinical signs, which significantly complicates the process of their diagnosis. A specific symptom in this pathology is considered to be a feeling of incomplete emptying of the bladder and a two-time urination. These symptoms develop due to the fact that part of the urine does not leave the urethra, but remains in the cavity of the diverticulum. After emptying the bladder, fluid from the diverticulum enters its cavity, which leads to the appearance of an additional portion of urine.

More vivid clinical symptoms can develop with complications of the diverticulum of the bladder. Quite often in the cavity of the latter can form stones and tumors. This leads to pain in the lower abdomen, clouding or redness of urine.

Diagnosis of bladder diverticula

Laboratory parameters of blood and urine vary only in the presence of these complications of diverticula. This may be the presence of blood or salts in a general urine test. In all other cases, laboratory blood counts remain absolutely calm.

Survey radiography of abdominal organs, as a rule, does not give any result in the diagnosis of diverticula of the bladder, therefore, its conduct for suspected pathology is considered impractical.

A reliable method of verification of this diagnosis is cystography, which consists in the introduction of a contrast medium into the cavity of the bladder followed by X-ray examination. In the picture, a bladder with a tumor-like protrusion on one of its walls is visualized. The screening technique for diverticulum is an act of urination. If after that the tumor-like protrusion disappears, then it really is a diverticulum.

Bladder diverticulum on cystography

Exactly the same principle can be used and excretory urography. The only difference in its conduct is that in this case, the contrast is not introduced through the urethra, but intravenously. As a rule, excretory urography is performed in the case when it is necessary to exclude the pathology of the kidneys or ureters and confirm the diagnosis of the diverticulum of the bladder.

A more modern and more reliable method of diagnosing diverticula of the bladder is cystoscopy. It involves examination of the mucous membrane of the bladder with a special optical device, which is inserted through the urethra. Visually, the diverticulum of the bladder looks like an additional stroke that opens into the blind cavity.

Ultrasound, which is also recommended for all patients with suspected bladder diverticulum, may indicate the presence of additional formation in a pelvis filled with fluid.

In some cases, when there is a possibility, you can conduct a CT scan of the pelvic organs. The images will visualize the formation, originating from the wall of the bladder, the same with it in consistency. To confirm the diagnosis, you can perform computed tomography with amplification, that is, with contrast.

Treatment of diverticula of the bladder

The main method of treatment of diverticula of the bladder is surgical intervention. The volume of the operation is to remove or bandage the saccule protrusion. Indications for surgery are complicated forms of diverticula, which are the causes of urolithiasis, urinary retention or cystitis.

diverticulum removal surgery In addition, the tactics of treating diverticula( meaning, acquired) should include measures to eliminate the causes that led to the retention of urine. It can be surgery to remove stones, tumors or adenomas of the prostate gland.

Because cystitis often develops after the operations on the bladder, patients are given intravenous and intravesical administration of antiseptic drugs, which mainly affect the flora of the urinary tract. To date, among these pharmacological drugs can be identified furamag or furadonin. They can be purchased at a pharmacy on the prescription of a doctor.

In the case of uncomplicated diverticula, expectant management tactics are used, which consists in outpatient monitoring of the patient. Quite often it happens that the diverticulum does not progress and does not affect the patient's well-being. Such cases, as a rule, do not need treatment.

Treatment with folk remedies

Treatment with folk remedies, as a rule, does not have any effect. When urine retention, traditional medicine recommends the use of diuretics. The latter lead to the formation of more urine, which, as before, lingers in the bladder. Thus, traditional methods of treatment do not have any positive effect in the treatment of diverticula of the bladder.

Features of nutrition and lifestyle

To relieve pressure in the bladder cavity in order to prevent the reappearance of diverticulum and the discrepancy of a postoperative wound, patients are advised to use a urethral catheter. Patients are explained the rules of care of the catheter. The latter must change at least once a week to a new one. In addition, the urine reservoir should be constantly emptied, in order to not reverse the transfer of fluid into the bladder and secondary infection.

Also in the bladder cavity on the urethral catheter are constantly injected solutions of antiseptics, which prevent infections associated with the urethral catheter.

In the postoperative period, patients are assigned a special diet that reduces the acidity of urine. This is done to ensure that the wound of the bladder heals faster. The diet of patients excludes alcohol and any salty foods, which leads to an increase in the acidity of urine.

Rehabilitation after

As already mentioned, even in the postoperative period, patients need intravesical administration of a solution of antiseptics. This is done to prevent secondary infection and prompt wound healing.

In addition, quite often patients for early recovery are prescribed physiotherapeutic procedures in the form of UHF.They can have both general and local character. In the case of the latter, a special urethral sensor is used.

Complications of bladder diverticula

The most common complication of diverticula of the bladder is cystitis. It develops due to stagnation of the urine in the cavity of the diverticulum. Inflammation of the mucosa is first localized in the diverticulum, and later spreads to the rest of the mucous membrane. For the same reason, urolithiasis can develop. With the development of the latter, patients begin to complain of constant pain in the lower abdomen, both during urination and at rest. Urine with this pathology becomes somewhat duller than normal, and sometimes has a red blood sediment.

There are also cases in the literature where a tumor of this organ developed due to a diverticulum of the bladder.

Many more complications with diverticula of the bladder develops after the operation. Firstly, because of poor antibacterial treatment, postoperative cystitis may develop with the suppuration of the operating wound. Also, due to inadequate decompression of the bladder cavity, a second diverticulum may form and a bladder rupture at the seams.

Prevention of diverticula of the bladder

Prevention of congenital diverticula, as well as other hereditary pathology, is not fully developed. Future parents are advised to restrain from drinking alcohol, diagnosing and treating infectious diseases that can affect fetal development, as well as healthy eating.

Prevention of acquired diverticula should be, first of all, in the treatment of those diseases that can lead to increased pressure inside the bladder. As a rule, it is prostate adenoma or cancer of this organ. Also, there are cases when diverticula arise from the stone of the bladder, which blocked the opening of the urethra. In this situation, the greatest role in the occurrence of protrusion in the wall of the bladder is played by a sharp increase in pressure, to which the bladder does not have time to adapt.

If there is no possibility of radical treatment of diseases of the prostate gland, a urethral catheter is placed to prevent the bladder diverticula, which can relieve the bladder before the operation.

Rev.doctor urologist Astashin Е.Е.