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Sharma A, Biswal D, Sharma S, Roy S. An elderly male with lower urinary tract symptoms during COVID-19 pandemic: Extraperitoneal perforation of bladder diverticulum. Urologia 2023; 90:763-765. [PMID: 34082626 DOI: 10.1177/03915603211022945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
CASE We present a case of spontaneous extra-peritoneal rupture of an acquired diverticulum an elderly male with symptoms of bladder outlet obstruction who presented in emergency with acute abdomen. OUTCOME The acute phase was managed conservatively with bladder drainage and intravenous antibiotics. He recently underwent Transurethral Resection of Prostate. He is asymptomatic on follow-up. CONCLUSIONS Acquired bladder diverticulum are rare in adults and are mostly seen in patients with high pressure bladder due to bladder outlet obstruction. Atraumatic extraperitoneal ruptures of diverticulum are uncommonly reported.
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Affiliation(s)
- Amit Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Deepak Biswal
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Satyadeo Sharma
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
| | - Siddhant Roy
- Department of Urology, All India Institute of Medical Sciences, Raipur, Chhattisgarh, India
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2
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Experimental long-term diabetes mellitus alters the transcriptome and biomechanical properties of the rat urinary bladder. Sci Rep 2021; 11:15529. [PMID: 34330963 PMCID: PMC8324824 DOI: 10.1038/s41598-021-94532-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 06/30/2021] [Indexed: 02/04/2023] Open
Abstract
Diabetes mellitus (DM) is the leading cause of chronic kidney disease and diabetic nephropathy is widely studied. In contrast, the pathobiology of diabetic urinary bladder disease is less understood despite dysfunctional voiding being common in DM. We hypothesised that diabetic cystopathy has a characteristic molecular signature. We therefore studied bladders of hyperglycaemic and polyuric rats with streptozotocin (STZ)-induced DM. Sixteen weeks after induction of DM, as assessed by RNA arrays, wide-ranging changes of gene expression occurred in DM bladders over and above those induced in bladders of non-hyperglycaemic rats with sucrose-induced polyuria. The altered transcripts included those coding for extracellular matrix regulators and neural molecules. Changes in key genes deregulated in DM rat bladders were also detected in db/db mouse bladders. In DM rat bladders there was reduced birefringent collagen between detrusor muscle bundles, and atomic force microscopy showed a significant reduction in tissue stiffness; neither change was found in bladders of sucrose-treated rats. Thus, altered extracellular matrix with reduced tissue rigidity may contribute to voiding dysfunction in people with long-term DM. These results serve as an informative stepping stone towards understanding the complex pathobiology of diabetic cystopathy.
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Oh SB, Ahn JH. Successful conservative management of a spontaneous intraperitoneal rupture of bladder diverticulum in a critical patient: A case report. A CARE-compliant article. Medicine (Baltimore) 2020; 99:e19262. [PMID: 32049867 PMCID: PMC7035120 DOI: 10.1097/md.0000000000019262] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE A spontaneous rupture of the bladder diverticulum in an adult patient is extremely rare. The recommended treatment is surgery. However, some cases can be successfully treated with urinary catheterization, antibiotics, and/or percutaneous peritoneal drainage. In this case report, a spontaneous rupture of the bladder diverticulum was successfully treated non-surgically because it was deemed too risky for surgical intervention, such as non-ST segment elevation myocardial infarction (NSTEMI). PATIENT CONCERNS A 76-year-old man presented with abdominal pain, distention, diarrhea, and oliguria for 3 days and hypotension for 1 day with no history of trauma. The patient showed direct and rebound tenderness in the lower abdomen. Computed tomography revealed an intraperitoneal bladder rupture associated with the bladder diverticula. Electrocardiography, echocardiography, and elevated cardiac enzyme suggested NSTEMI. DIAGNOSES A spontaneous rupture of the bladder diverticulum, NSTEMI, and suspected sepsis due to gastroenteritis or urinary infection. INTERVENTIONS The patient was treated conservatively with urinary catheterization and antibiotics for a bladder rupture and an infection. Percutaneous transluminal coronary angioplasty was performed for NSTEMI. OUTCOMES The patient fully recovered without complications on hospitalization day 13. LESSONS Conservative management might be an alternative for a spontaneous intraperitoneal bladder rupture in some cases. However, close observation is required, and surgical intervention is the first option for a spontaneous intraperitoneal rupture of the bladder diverticulum.
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Affiliation(s)
- Seong Beom Oh
- Department of Emergency Medicine, Dankook University School of Medicine, Cheonan
| | - Jung Hwan Ahn
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Gilliam E, Hoffman JD, Yeh G. Urogenital and pelvic complications in the Ehlers-Danlos syndromes and associated hypermobility spectrum disorders: A scoping review. Clin Genet 2020; 97:168-178. [PMID: 31420870 PMCID: PMC6917879 DOI: 10.1111/cge.13624] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 08/07/2019] [Accepted: 08/14/2019] [Indexed: 12/19/2022]
Abstract
The Ehlers-Danlos syndromes (EDS) and associated hypermobility spectrum disorders (HSD) are a heterogenous group of connective tissue disorders associated with significant morbidity. The urogenital aspects of these disorders are understudied and there is little guidance on the prevalence, types, or outcomes of urogenital complications in EDS/HSD. Our objective was to perform a scoping review to characterize and synthesize the literature reporting urogenital and pelvic complications in EDS/HSD patients. We performed a systematic search of three databases (Medline, CINAHL, Embase) to January 2019. English language, full-text articles reporting on urogenital or pelvic complications in EDS/HSD were included. A total of 105 studies were included (62 case reports/series, 43 observational) involving patients with hypermobile (23%), vascular (20%), classical (12%) EDS, and HSD (24%). Some studies looked at multiple subtypes (11%) or did not report subtype (33%). Reported complications included urinary (41%), gynecological (36%), obstetrical (25%), renal (9%), and men's health problems (7%), with some studies reporting on multiple areas. Urinary and gynecological complications were most prevalent in patients with HSD, while a broad range of complications were reported in EDS. While further research is required, results suggest a higher index of suspicion for urogenital problems is probably warranted in this population.
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Affiliation(s)
- Elizabeth Gilliam
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jodi D. Hoffman
- Division of Genetics, Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Gloria Yeh
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Britto MM, Yao HHI, Campbell N. Delayed diagnosis of spontaneous rupture of a congenital bladder diverticulum as a rare cause of an acute abdomen. ANZ J Surg 2018; 89:E385-E387. [DOI: 10.1111/ans.14559] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/11/2018] [Accepted: 03/17/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Maneka M. Britto
- Department of UrologyThe Alfred Hospital Melbourne Victoria Australia
| | - Henry H. I. Yao
- Department of UrologyThe Alfred Hospital Melbourne Victoria Australia
- Department of UrologyEastern Health Melbourne Victoria Australia
| | - Nicholas Campbell
- Department of UrologyThe Alfred Hospital Melbourne Victoria Australia
- Department of UrologyEastern Health Melbourne Victoria Australia
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6
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Spontaneous Bladder Rupture Masquerading as Pseudo-diverticulum. Urol Case Rep 2017; 12:73-75. [PMID: 28377891 PMCID: PMC5377291 DOI: 10.1016/j.eucr.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/08/2017] [Indexed: 11/21/2022] Open
Abstract
Spontaneous bladder rupture is rare. Presentation is non-specific and in absence of history of trauma, radiation, inflammatory conditions and other leading causes, there is considerable diagnostic delay. Absence of clear cut diagnostic signs leads to increased morbidity and mortality. In many patients, omentum seals perforation, giving diverticular appearance in Cystogram. The objective of this case report is to highlight important specific diagnostic points in history and radiology which will help in clear, early diagnosis and treatment causing immense benefit to the patient. We would also like to highlight a specific radiological point to distinguish true from pseudo-diverticulum.
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7
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Tokhmafshan F, Brophy PD, Gbadegesin RA, Gupta IR. Vesicoureteral reflux and the extracellular matrix connection. Pediatr Nephrol 2017; 32:565-576. [PMID: 27139901 PMCID: PMC5376290 DOI: 10.1007/s00467-016-3386-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 03/18/2016] [Accepted: 03/21/2016] [Indexed: 12/24/2022]
Abstract
Primary vesicoureteral reflux (VUR) is a common pediatric condition due to a developmental defect in the ureterovesical junction. The prevalence of VUR among individuals with connective tissue disorders, as well as the importance of the ureter and bladder wall musculature for the anti-reflux mechanism, suggest that defects in the extracellular matrix (ECM) within the ureterovesical junction may result in VUR. This review will discuss the function of the smooth muscle and its supporting ECM microenvironment with respect to VUR, and explore the association of VUR with mutations in ECM-related genes.
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Affiliation(s)
| | - Patrick D. Brophy
- Department of Pediatrics, University of Iowa, Carver College of Medicine, Iowa City, IA 52242, USA
| | - Rasheed A. Gbadegesin
- Department of Pediatrics, Division of Nephrology, Duke University Medical Center, Durham, NC 27710, USA,Center for Human Genetics, Duke University Medical Center, Durham, NC 27710, USA
| | - Indra R. Gupta
- Department of Human Genetics, McGill University, Montreal, QC, Canada,Department of Pediatrics, McGill University, Montreal, QC, Canada
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8
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Oxenham J. Complexities of management of a urostomy in Ehlers-Danlos syndrome: a reflective account. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2016; 25:S14-9. [PMID: 26973007 DOI: 10.12968/bjon.2016.25.5.s14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Mary (pseudonym) is a 30-year-old woman who underwent a urinary diversion and formation of an ileal conduit/urostomy (urinary stoma) due to the formation of multiple bladder diverticula, which caused micturition difficulties and recurrent urinary tract infections with associated pain and discomfort. The bladder diverticula were caused by Ehlers-Danlos syndrome (EDS), a hereditary disorder of the connective tissue or, particulary, defective collagen. Surgical intervention in patients with EDS is prone to complications due to poor wound healing, including issues of dehiscence, postoperative bleeding and poor uptake of anaesthesia and analgesia. After an initial presentation of the syndrome of EDS and Mary's history, this article offers a reflective account (informed by Gibbs' Reflective Cycle) and illustrates the complexities of caring for an individual with EDS who undergoes stoma formation. The author, a stoma care nurse, demonstrates how using purposeful reflection resulted in better understanding and awareness of caring for an individual with a rare syndrome and the nursing challenges this presented.
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Affiliation(s)
- Julie Oxenham
- Clinical Nurse Specialist, Stoma Care, Hollister Ltd
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10
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Affiliation(s)
| | | | | | | | - Stephen Ruthven
- Head of the Department of Urology, Gosford District Hospital, Gosford, NSW, 2250, Australia
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11
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Zengin K, Tanik S, Gürdal M, Okur A, Zengin B. Vaginal mass caused by a lately recognized congenital bladder diverticulum. Can Urol Assoc J 2013; 7:E634-E636. [PMID: 24409212 PMCID: PMC3886201 DOI: 10.5489/cuaj.247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Congenital bladder diverticula are strongly associated with vesicoureteral reflux (VUR), and are mostly present in childhood. The most common symptom is urinary tract infection at the time of admission. The diverticulum is usually solitary and its location is near the ureteral orifice, which is probably the main cause of VUR. We report a woman who presented with a vaginal mass located on the right inferior part of the external urethral meatus. The patient had a history of recurrent urinary tract infection and right nephrectomy due to VUR nephropathy. We examined her with cystography, computerized tomography, and cystoscopy. The cystoscopic examination was very diagnostic in our patient. The patient underwent diverticulectomy, and after 6 months of follow-up, her complaints had completely disappeared.
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Affiliation(s)
- Kürşad Zengin
- Faculty of Medicine, Department of Urology, Bozok University, Yozgat, Turkey
| | - Serhat Tanik
- Faculty of Medicine, Department of Urology, Bozok University, Yozgat, Turkey
| | - Mesut Gürdal
- Faculty of Medicine, Department of Urology, Bozok University, Yozgat, Turkey
| | - Aylin Okur
- Faculty of Medicine, Department of Radiology, Bozok University, Yozgat, Turkey
| | - Betül Zengin
- Radiology Clinics, Yozgat State Hospital, Yozgat, Turkey
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12
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Rasouly HM, Lu W. Lower urinary tract development and disease. WILEY INTERDISCIPLINARY REVIEWS. SYSTEMS BIOLOGY AND MEDICINE 2013; 5:307-42. [PMID: 23408557 PMCID: PMC3627353 DOI: 10.1002/wsbm.1212] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Congenital anomalies of the lower urinary tract (CALUT) are a family of birth defects of the ureter, the bladder, and the urethra. CALUT includes ureteral anomaliesc such as congenital abnormalities of the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ), and birth defects of the bladder and the urethra such as bladder-exstrophy-epispadias complex (BEEC), prune belly syndrome (PBS), and posterior urethral valves (PUVs). CALUT is one of the most common birth defects and is often associated with antenatal hydronephrosis, vesicoureteral reflux (VUR), urinary tract obstruction, urinary tract infections (UTI), chronic kidney disease, and renal failure in children. Here, we discuss the current genetic and molecular knowledge about lower urinary tract development and genetic basis of CALUT in both human and mouse models. We provide an overview of the developmental processes leading to the formation of the ureter, the bladder, and the urethra, and different genes and signaling pathways controlling these developmental processes. Human genetic disorders that affect the ureter, the bladder and the urethra and associated gene mutations are also presented. As we are entering the postgenomic era of personalized medicine, information in this article may provide useful interpretation for the genetic and genomic test results collected from patients with lower urinary tract birth defects. With evidence-based interpretations, clinicians may provide more effective personalized therapies to patients and genetic counseling for their families.
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Affiliation(s)
- Hila Milo Rasouly
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
| | - Weining Lu
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA 02118, USA
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13
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Abstract
This review of bladder diverticula in children includes: historical aspects of the condition, its presentation and diagnosis, as well as management options. The purpose of the review is to provide a comprehensive and in-depth understanding of a relatively infrequent but clinically challenging urologic abnormality that may affect not only the bladder but also the upper urinary tract and kidney.
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Affiliation(s)
- Sarah P Psutka
- Children's Hospital Boston Department of Urology, Boston, MA 02115, USA
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14
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Trigui L, Jallouli M, Hmida N, Mnif Z, Mhiri R, Gargouri A. Iatrogenic neonatal bladder perforation. Urol Ann 2011; 3:108-9. [PMID: 21747605 PMCID: PMC3130474 DOI: 10.4103/0974-7796.82181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2010] [Accepted: 08/10/2010] [Indexed: 11/15/2022] Open
Abstract
Neonatal bladder rupture is rare as a complication of bladder obstruction due to abnormal anatomy or iatrogenic causes. The present study describes the case of a 3-day-old infant with ascites due to bladder perforation secondary probably to manual decompression of the bladder. The infant underwent successful surgical repair of the perforation.
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Affiliation(s)
- Lilia Trigui
- Department of Neonatology, Hedi Chaker Hospital, Sfax, Tunisia
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15
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Nae IC, Chevet JB, Delaporte B. [An unusual etiology of neonatal renal insufficiency: the spontaneous rupture of the bladder]. Arch Pediatr 2011; 18:276-8. [PMID: 21295453 DOI: 10.1016/j.arcped.2010.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Revised: 01/06/2010] [Accepted: 12/19/2010] [Indexed: 11/19/2022]
Abstract
Postnatal urinary ascites is a rare occurrence compared with other causes of peritoneal effusion at this age and its frequency in prenatal diagnosis. Spontaneous rupture of the bladder was diagnosed in a premature male infant presenting with postnatal ascites and anuric renal insufficiency. Surgical repair was required. No predisposing factor was associated with this rare complication. The urinary origin of the ascites was diagnosed based on the biochemical composition, allowing us to understand its mechanism and to treat it.
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Affiliation(s)
- I-C Nae
- Service de réanimation néonatale et de surveillance continue pédiatrique, groupe hospitalier, 76083 Le Havre cedex, France
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Wiygul J, Palmer LS. Spontaneous bladder perforation in a neonate. Urology 2010; 76:164-5. [PMID: 20363492 DOI: 10.1016/j.urology.2009.12.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 12/14/2009] [Accepted: 12/23/2009] [Indexed: 11/28/2022]
Abstract
Spontaneous bladder perforation in the newborn setting is a rare clinical phenomenon that can be life threatening if left untreated. Several risk factors have been identified in previously reported cases such as hypoxia and bladder diverticula. We present the first case of neonatal bladder rupture without any identifiable risk factors.
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Affiliation(s)
- Jeremy Wiygul
- Division of Pediatric Urology, Schneider Children's Hospital of the North Shore-Long Island Jewish Health System, Long Island, New York, USA
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Sanchez F, Prieto JC, Baker LA. Spontaneous bladder rupture in non-augmented bladder exstrophy. J Pediatr Urol 2008; 4:325-8. [PMID: 18644542 DOI: 10.1016/j.jpurol.2007.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2007] [Accepted: 12/03/2007] [Indexed: 11/30/2022]
Abstract
Childhood spontaneous bladder rupture is an uncommon event, usually associated with bladder augmentation. Occasionally it occurs in normal bladders or non-augmented bladders with a predisposing factor. We present a unique case of misdiagnosed spontaneous bladder rupture in a non-augmented bladder exstrophy patient without evidence of lower urinary outlet obstruction. His acute abdomen mimicked appendicitis and was managed with laparoscopic exploration, intraperitoneal fluid drainage, appendectomy and bladder drainage. This case highlights the need for pediatric urological consultation by surgeons in the case of an acute abdomen with free fluid in a patient with an abnormal bladder.
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Affiliation(s)
- Fabian Sanchez
- Pediatric Urology, Children's Medical Center at Dallas, University of Texas Southwestern Medical Center, Dallas, TX 75207, USA
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18
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Garat JM, Angerri O, Caffaratti J, Moscatiello P, Villavicencio H. Primary Congenital Bladder Diverticula in Children. Urology 2007; 70:984-8. [DOI: 10.1016/j.urology.2007.06.1108] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Revised: 04/23/2007] [Accepted: 06/26/2007] [Indexed: 11/25/2022]
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Ketata S, Boulaire JL, Al-Ahdab N, Bargain A, Damamme A. Spontaneous Intraperitoneal Perforation of the Bladder: A Late Complication of Radiation Therapy for Prostate Cancer. Clin Genitourin Cancer 2007; 5:287-90. [PMID: 17553210 DOI: 10.3816/cgc.2007.n.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The spontaneous intraperitoneal rupture of the urinary bladder is an extremely rare and life-threatening event. Often, there are difficulties in establishing the diagnosis. A patient with spontaneous perforation of the urinary bladder, 17 years after successful treatment of an adenocarcinoma of the prostate by pelvic radiation therapy, is reported. Aspects of etiology, clinical presentation, diagnosis, and management are described. Early surgical exploration including primary closure of the defect, peritoneal lavage, and continuous vesical drainage were associated with a favorable outcome.
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Affiliation(s)
- Sabeur Ketata
- Department of Urology, Centre Hospitalier of Saint Malo, France.
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20
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Stein RJ, Matoka DJ, Noh PH, Docimo SG. Spontaneous perforation of congenital bladder diverticulum. Urology 2005; 66:881. [PMID: 16230171 DOI: 10.1016/j.urology.2005.04.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2004] [Revised: 03/14/2005] [Accepted: 04/14/2005] [Indexed: 11/24/2022]
Abstract
A traumatic rupture of the bladder in a healthy child is extremely rare and is usually not considered during evaluation of abdominal pain or sepsis. However, a delay in the diagnosis of bladder perforation can result in morbid and sometimes catastrophic outcomes. We report a delayed diagnosis of spontaneous rupture of a congenital bladder diverticulum in a previously healthy child. This case demonstrates that spontaneous bladder rupture may be a rare cause of abdominal complaints and sepsis when the etiology at first seems unclear.
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Affiliation(s)
- Robert J Stein
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213, USA.
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Abstract
PURPOSE The aim of this study was to review the authors' surgical experience with primary bladder diverticula in the pediatric population, with special attention to associated urinary tract infections and voiding dysfunction. METHODS A retrospective review yielded 21 pediatric patients with primary bladder diverticula treated surgically over a 13-year span. Patients with secondary diverticula were excluded. Charts were reviewed and patients were contacted in regards to several factors. Diverticula were diagnosed preoperatively by radiography on a voiding cystourethrogram. Diverticula, which were only found intraoperatively and not on VCUG, were not included in the study. RESULTS Mean age at presentation was 8.16 years (range of 0.17-12.91 years). The sex predominance was male, 17 (81%) of 21. Mean follow-up was 44.2 months (range of 6-156 months). The diverticula were associated with ureters requiring reimplantation in 15 of 21 patients (72.4%); only 6 (28.6%) of 21 were isolated diverticula. Nineteen (90.5%) of 21 patients presented with infections, and all 19 (100%) have had complete resolution of infections. Of the total, a subset of 6 patients with isolated diverticula and no evidence of reflux had total resolution of their infections. Twelve patients presented with voiding dysfunction. Eight of these 12 patients had improvement of their voiding dysfunction with complete resolution in 2 patients. CONCLUSIONS In this series, infections were eliminated with surgical excision of the primary diverticula. Surgical repair was also associated with improvement of voiding dysfunction.
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