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[Functional changes in the bladder of children with primary bladder diverticulum]
R Martín-Crespo Izquierdo1, R Luque Mialdea, J Antonio Navascués
1Sección de Urología, Hospital General Universitario Gregorio Marañón, Madrid, España.
Insights
Primary vesical diverticulum in children often causes urinary dysfunction. Urodynamic studies are crucial for diagnosis and management, showing surgery effectively resolves bladder dysfunction associated with diverticula.
Area of Science:
- Pediatric Urology
- Urodynamics
- Congenital Anomalies
Context:
- Primary vesical diverticulum is a rare congenital anomaly.
- It is often diagnosed in children presenting with recurrent urinary tract infections and urinary dysfunction.
- Vesicoureteral reflux is a common associated condition.
Purpose:
- To evaluate the role of urodynamic studies in diagnosing vesicourethral dysfunction in children with primary vesical diverticulum.
- To assess the relationship between vesical diverticulum, vesicourethral dysfunction, and vesicoureteral reflux.
- To compare the outcomes of surgical versus conservative management for primary vesical diverticulum.
Summary:
- A urodynamic study was performed on 11 children (aged 6-13) with primary vesical diverticulum.
- 73% of patients exhibited abnormal urodynamic findings, including uncoordinated vesicosphincteric function, bladder instability, and bladder hypotonia.
- Surgical treatment resolved urodynamic abnormalities in all 8 surgically treated children, while conservative management failed in 2 out of 3 cases.
Impact:
- Urodynamic studies should be included in the evaluation protocol for children with primary vesical diverticulum.
- Bladder dysfunction associated with vesical diverticulum may contribute to reflux and warrants surgical consideration.
- Findings support surgical intervention for primary vesical diverticulum when associated with significant bladder dysfunction.
Objective:
Primary vesical diverticulum is generally diagnosed during urological evaluation for recurrent urinary tract infection that are frequently associated with the symptoms of urinary dysfunction. A urodynamic study was performed in children with primary vesical diverticulum to confirm or discard the presence of vesicourethal dysfunction, its relationship with vesicoureteral reflux, which is associated with diverticulum, and the results achieved by surgical versus medical treatment.
Methods/Results:
A urodynamic study was carried out in 11 children (7 boys and 4 girls), aged 6 to 13 years, with primary vesical diverticulum. The diverticulum was parameatal in 7 cases (4 with reflux), posterolateral in 2 cases (1 with reflux), anterolateral in 1 patient and 1 patient had multiple bladder diverticula without neurological disorder. Surgery was indicated in 8 cases and 3 were managed conservatively. Vesicourethral function, at the time the diverticulum was diagnosed, was normal in 3 (27%) and pathological in 8 (73%) patients. The urodynamic study disclosed uncoordinated vesicosphincteric function (4 pts), vesical instability (3 pts) and vesical hypotony (1 pt). Of these 4 cases with urodynamic disorders, diverticulum was associated with vesicoureteral reflux. Of the 8 children submitted to surgery, 6 had a functional pathology preoperatively; following surgical treatment of the diverticulum, vesicourethral function returned to normal in all cases. Of the 3 cases managed conservatively, 2 had persistent urodynamic disorders despite drug therapy; one of them had clinical features of urinary incontinence.
Conclusions:
These fundings suggest that alterations of bladder function might arise from the anatomic changes in the detrusor muscle causing the diverticulum and contribute to the onset or persistence of reflux, and should be considered an additional criterion for indicating surgery. It is therefore suggested that a urodynamic study for its diagnosis be included in the protocol for evaluation of children with primary vesical diverticulum.