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Observations on vesical diverticulum in childhood
Insights
Vesical diverticula in children often cause vesicoureteral reflux and upper tract issues. Surgical treatment involving diverticulectomy and ureteroneocystostomy is highly successful.
Area of Science:
- Pediatric Urology
- Surgical Innovation
- Renal Tract Pathology
Background:
- Vesical diverticula, outpouchings of the bladder, can occur in children.
- These diverticula are frequently associated with vesicoureteral reflux and potential upper tract damage.
- Bladder outlet obstruction is not always present in pediatric cases.
Purpose of the Study:
- To evaluate the surgical management of vesical diverticula in children without bladder outlet obstruction.
- To assess the association between diverticula, vesicoureteral reflux, and upper tract changes.
- To determine the most effective surgical intervention for these conditions.
Main Methods:
- Retrospective analysis of 78 children undergoing surgery for vesical diverticula.
- Correlation of diverticulum location with ureteral orifices and vesicoureteral reflux.
- Assessment of upper tract changes via excretory urography.
- Evaluation of surgical outcomes for different procedures.
Main Results:
- 89 diverticulum-ureteral units were analyzed; 83 were associated with vesicoureteral reflux.
- Upper tract changes were observed in 78% of refluxing units.
- Diverticulectomy combined with ureteroneocystostomy demonstrated a high success rate.
Conclusions:
- Vesical diverticula in children, even without obstruction, frequently lead to vesicoureteral reflux and renal damage.
- Diverticulectomy and ureteroneocystostomy is the preferred surgical approach.
- Isolated diverticulectomy or vesical neck revision has limited indications.
Abstract:
An operation was required in 78 children with vesical diverticula in the absence of bladder outlet obstruction. Virtually all diverticula were located in juxtaposition to the ureteral orifice and were associated with vesicoureteral reflux in all but 6 of 89 diverticulum-ureteral units. Upper tract changes were seen on excretory urography in 78 per cent of the refluxing units. The surgical procedure of choice was diverticulectomy and ureteroneocystostomy, which yielded a high degree of success. Diverticulectomy alone and vesical neck revision were rarely indicated.