Diverticulum of the bladder: treatment, causes and symptoms
If you experience shortness of urination, which is expressed in the necessity of its implementation to effect a complete discharge in two stages, the doctor can diagnose, that in the wall of the bladder diverticulum is formed. It is a kind of sack, coupled with the cavity channel.
What is the danger of diverticula
The main risk that threatens the woman, if it is in the area of the bladder diverticulum is present, is that going to be constantly extending completely stagnate urine. For this reason, there are a number of pathological changes, which include cystitis, urolithiasis, tumors, hydronephrosis, pyelonephritis.
Localizes the diverticula most often on the side or rear wall of the bladder, having different dimensions. Sometimes dimensions exceed the volume of the bubble.
Taking as a benchmark against which the diverticula are classified, the time of their formation, we can distinguish primary and secondary forms. The primary types include birth education, and the secondary, respectively acquired pathological changes due to various reasons. Clinical urology captures most of the second type.
According to quantitative indicators allocated to multiple or single plus the cavity of the bladder. Depending on the structure of the diverticulum is described in the medical practice in two ways:
- true — if the wall has the same layers (sheath mucosa, submucosa basis, muscle tissue, the outer layer cover), and the bubble;
- false — if the wall is only the mucous layer of the bladder that protrudes out through the remaining fibers of the detrusor.
When the comparison reveals that the false types usually are acquired diverticula, and to the true, innate education.
The reasons for the formation
Congenital diverticulum of the initial impetus to education is development of abnormal layers of the bladder wall, causing the weakness of the detrusor.
Acquired negative cavitary formation is formed, if a long time it creates a high intravesical pressure, which may be due to sclerotic changes in the neck of the bladder.
- If the diverticulum has a small size, the inconvenience may not deliver. If it starts growing, and gradually develop the characteristic symptoms.
- Appears clearly perceptible obstacle during voiding when urine flows twice, because she first comes out of the bladder, and then must exit from the cavity of the diverticulum.
- Significantly increases the duration of urination.
- Sometimes there is hematuria, and blood traces in the urine.
- May have pyuria – the appearance of pus in the urine.
- A serious indicator requiring immediate medical intervention, is the cessation of urine output.
The diverticulum is usually detected, if a patient calls about other diseases, for example, it brings anxiety chronic cystitis or recurrent pyelonephritis.
To clarify the suspicion, appointed by ultrasound. Also is cystoscopy, which is a visual examination through the introduction into the bladder cystoscope – instrument with an embedded camera.
If necessary, can be shown cystography. Before doing x-rays is injected into the area of study of a special contrast solution. When emptying, the substance, pausing in the diverticulum shows in the picture size of cavitary education and its location.
Ultrasound can further confirm the dimensions, location, shape of the diverticulum, the diameter of its neck, and to determine the associated structural changes in the form of stones or tumors.
To treatment was assigned in full is required to confirm whether infravesical obstruction is a blockage of the urethra. This will require urodynamic examination, which include uroflowmetry (measurement of urine flow rate), cystometry (detection of the bladder volume and pressure inside it).
Methods of treatment
A small diverticulum, not cause of anxiety and not provoke negative effects in the form of inflammation and disorders of urination, the doctor leaves, making a schedule for regular monitoring of his condition. If education is not progressing, then treatment may not be required.
If the diagnostics indicate that the diverticulum reached a considerable size, resulting in stasis of urine, resulting in the formation of stones or tumor formation that is assigned to the operative treatment method.
Modern surgery in the Arsenal has two methods of surgery: traditional open and endoscopic.
Normal operation allows you to perform a complete excision of the diverticulum. Is done open suprapubic incision and stands out for surgery bladder. Then there is the diverticulum and clipped in his neck. Sutured wound successively in layers and drained.
If this surgical treatment is a risk of damage to adjacent organs, then use an alternative method, involving initial eversion of the diverticulum inside the bladder, where it is cut off.
The detection of the diverticulum attached to the bladder through a narrow neck, usually used more gentle treatment – laparoscopic diverticulectomy. This requires making four small incision for the introduction of specialized tools. To identify the operated education, is a cystoscopy, introducing into the bladder through the urethra, a cystoscope with a miniature video camera.
With the help of endoscopic instruments is allocated diverticulum, consistently special brackets stitched to his neck and cut off the education. The inner side is checked through the camera quality of the weld. Cut off part is removed through one of the punctures.
Surgical treatment in parallel with the excision of the diverticula to eliminate other reasons for urinary retention, tumors, stones, prostate adenoma.
The postoperative period
After the surgery in order to relieve excessive pressure in the cavity is set urethral catheter. This measure promotes rapid healing of the wound sewn. To exclude the development of cystitis, inside of the bladder using a catheter or syringe mounted antiseptic preparations.
To treatment has received a positive final result, the patient, the doctor gives detailed recommendations for the care of the catheter, which is subject to weekly replacement. Reservoir for urine must be freed in a timely manner to prevent backward falling of the released fluid into the urethra.
Includes rehabilitation physiotherapy through UHF procedures. You also need to adhere to a dietary diet, which is being developed with the purpose of lowering the pH of urine. From the menu excludes pickles, alcohol.
The most frequent postoperative complication is suppuration of the wound, if the treatment was carried out with violations. Due to bacterial infection can develop cystitis. If properly carried out decompression, there may be a gap or seam to form a diverticulum.