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Bladder diverticula in children - a clinical, radiologic and endoscopic study
Insights
Bladder diverticula and pouches in children can cause urinary tract infections and hematuria. Long-term follow-up shows these protrusions may develop into diverticula, potentially leading to further urinary tract abnormalities.
Area of Science:
- Pediatric Urology
- Urologic Imaging
- Pediatric Gastroenterology
Background:
- Bladder diverticula and posterolateral pouches are congenital or acquired abnormalities of the bladder wall.
- These conditions can present with various symptoms, including urinary tract infections (UTIs) and hematuria.
- Understanding their natural history and association with other urinary tract abnormalities is crucial for diagnosis and management.
Purpose of the Study:
- To describe the clinical, radiologic, and endoscopic findings in children with bladder diverticula and posterolateral bladder wall protrusions.
- To investigate the association between these bladder abnormalities and lower urinary tract obstruction or vesicoureteral reflux.
- To evaluate the long-term evolution of bladder wall protrusions and their potential to develop into true diverticula.
Main Methods:
- Retrospective review of clinical data, imaging (radiologic), and cystoscopic findings in 93 children (84 with bladder diverticula, 9 with posterolateral pouches).
- Classification of bladder diverticula based on presence or absence of lower urinary tract obstruction.
- Assessment of vesicoureteral reflux (VUR) in relation to diverticula size, obstruction, and pouch morphology.
Main Results:
- A novel 'walnutshell-like' bladder diverticulum was described cystoscopically.
- Urinary tract infections were the most common symptom; hematuria was frequent with walnutshell-like diverticula.
- Of 84 children with bladder diverticula, 66 had no obstruction; 18 had obstruction-related diverticula. Vesicoureteral reflux was present in 34/66 (51.5%) of non-obstructed diverticula cases and 8/9 (88.9%) of posterolateral pouches.
- Saccules (diverticula < 2 cm) were noted in 20 of the non-obstructed diverticula cases with VUR.
Conclusions:
- Any bladder wall protrusion, irrespective of size or opening, can evolve into a diverticulum associated with other urinary tract abnormalities.
- Posterolateral pouches can transform into true diverticula, potentially leading to the development of vesicoureteral reflux.
- Early identification and monitoring of bladder wall protrusions are important in pediatric urology to prevent complications.
Abstract:
We have described the clinical, radiologic and endoscopic findings in 84 children with bladder diverticula and 9 children with posterolateral pouch-like protrusions of the bladder wall. Cystoscopically, a new bladder diverticulum is described, resembling a walnutshell. The majority of children had symptoms of urinary tract infection, the walnutshell-like diverticula was frequently associated with haematuria. In 66 or 84 children with bladder diverticula and in 9 children with posterolateral pouches no obstruction of the lower urinary tract was found. Diverticula caused by obstruction were found in 18 cases. Vesicoureteral reflux was present in 34 of 66 children with diverticula without obstruction of the lower urinary tract, in 20 of these there were saccules (diverticula smaller than 2 cm in diameter). Vesicoureteral reflux was found in 8 of 9 children with posterolateral pouches of the bladder wall. Long term follow-up suggests that any protrusion of the bladder wall, regardless of the size of cavity and the shape of the opening, may become a diverticulum associated with further abnormalities of the urinary tract. In 3 patients with postero lateral pouches a transformation from pouches into true diverticula together with the development of vesicoureteral reflux was observed.