Lower urinary tract obstruction secondary to congenital bladder diverticula in infants

Congenital primary bladder diverticulum is a rare condition and may present with urinary infection; other forms of presentation are rare. We present a series of infants who presented with urinary retention secondary to large primary bladder diverticulum.

Seven infants were evaluated for symptoms of lower urinary tract obstruction. All seven were infant boys; three were neonates. Investigations included ultrasonogram, voiding cystourethrogram (VCUG) and cystoscopy.

Six infants had single large diverticulum while one had bilateral diverticula. VCUG was diagnostic in all cases demonstrating the mechanism of obstruction clearly except one where bilateral diverticula was diagnosed only on cystoscopy prior to definitive surgery. Five children (including one neonate) underwent successful definitive repair consisting of diverticulectomy and ureteral re-implant while two neonates were planned for a staged correction. One neonate later in the series underwent definitive primary repair as bladder was good sized. All five children have done well after definitive repair at a follow-up of 6-72 months.

Primary bladder diverticulum in infants may present with lower urinary obstructive symptoms indistinguishable from posterior urethral valves. A carefully done VCUG can help in diagnosis. Primary definitive repair can be undertaken even in first few months of life with good results.