Bladder Diverticulectomy with Ureteric Reimplantation Restored Normal Urination in a 17-Year-Old Patient
Introduction
Bladder diverticulum is an abnormal pouch-like outgrowth of the bladder wall that can collect urine and lead to incomplete bladder emptying, recurrent infections, and urinary complications.
Some patients may require long-term catheterization due to difficulty emptying the bladder. However, identifying the correct underlying cause is important to provide effective treatment.
This clinical case highlights the successful management of a large bladder diverticulum in a 17-year-old patient who had been dependent on Clean Intermittent Catheterization (CISC) since childhood.
Case Overview
Patient Profile
Age: 17 years
Previous Management: Clean Intermittent Self Catheterization (CISC) since the age of 8
Condition Treated: Large Bladder Diverticulum
Procedure Performed: Bladder Diverticulectomy with Ureteric Reimplantation
Specialty: Urology / Reconstructive Urinary Surgery
Clinical Challenge
The patient had been performing CISC every 6 hours for several years.
Despite catheterization, the patient had:
- Significant residual urine inside the bladder diverticulum
- Recurrent urinary infections
- Reduced quality of life
The patient had previously been considered to have a neurogenic bladder; however, evaluation showed no underlying neurological disorder.
The challenge was to identify the actual cause of poor bladder emptying and provide a treatment approach that could help the patient become independent of catheterisation.
Diagnosis and Evaluation
The evaluation revealed:
Ultrasound Findings
- Bladder outpouching measuring approximately 8.6 × 4.8 cm
- Connecting passage identified between bladder and diverticulum
CT Urography Findings
- Large diverticulum measuring approximately 8 × 4 × 6 cm
- Originating from the right lateral wall of the bladder
MCU (Micturating Cystourethrogram)
Findings showed:
- Large bladder diverticulum
- Normal calibre urethra
- Significant post-void residual urine
These investigations helped establish the diagnosis and plan surgical management.
Treatment Approach
Bladder Diverticulectomy with Ureteric Reimplantation
The patient underwent surgical removal of the bladder diverticulum.
The procedure included:
Diverticulectomy
Removal of the abnormal bladder pouch responsible for urine collection and residual urine.
Ureteric Reimplantation
The ureter was tunnelled and reimplanted to maintain proper urine drainage.
Key Highlights of the Case
- 17-year-old patient on CISC since age 8
- Large bladder diverticulum identified
- Initially considered neurogenic bladder, but no neurological disorder found
- Diverticulectomy performed with ureteric reimplantation
- Patient achieved normal voiding after surgery
- Freedom from long-term catheterisation
Procedure Benefits
The surgical approach aimed to:
- Remove the non-functional bladder outpouching
- Improve bladder emptying
- Reduce residual urine
- Help the patient become free from long-term catheter dependence
Post-Operative Outcome
Following surgery:
- Catheter was removed
- Patient was able to pass urine normally
- No significant post-void residual urine was observed on sonography
- Patient no longer required CISC
The procedure helped the patient achieve a better quality of life with improved bladder function.
Understanding Bladder Diverticulum
A bladder diverticulum is a pouch that forms in the bladder wall where urine can collect.
It may lead to:
- Incomplete bladder emptying
- Recurrent urinary infections
- Urinary retention
- Increased residual urine volume
Proper evaluation is important to identify the cause and determine the right treatment approach.
Frequently Asked Questions
What is a bladder diverticulum?
A bladder diverticulum is a pouch-like formation in the bladder wall where urine can collect and cause incomplete emptying.
Why is bladder diverticulectomy performed?
Bladder diverticulectomy is performed to remove a problematic diverticulum that causes urinary symptoms, infections, or significant residual urine.
What is ureteric reimplantation?
Ureteric reimplantation is a surgical procedure where the ureter is repositioned and connected to the bladder to maintain proper urine drainage.
Can bladder diverticulum cause recurrent infections?
Yes, urine trapped inside a diverticulum can increase the risk of recurrent urinary infections.
What is CISC?
Clean Intermittent Self Catheterisation is a technique where a patient uses a catheter at regular intervals to empty the bladder.
Related Treatment
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