Bladder diverticulitis

　　Bladder diverticulitis is often caused by secondary infection of bladder diverticula. It is less common in those under 40 years of age than in those over 40. However, it can be severe at any age. In patients under 50 years of age who require surgical treatment for diverticulitis, men are three times more than women; while in those over 70, women are three times more than men.

　　1. Etiology

　　Congenital lesions such as urethral stricture, posterior urethral valve, and bladder neck stenosis promote the formation and development of diverticula, which are the main factors for the formation of diverticula. Clinically, most patients with bladder neck obstruction do not develop diverticula, and some cases of diverticula do not have obstruction, so the formation of bladder diverticula is also related to congenital malalignment of bladder muscle fibers. Lower urinary tract obstruction and high pressure are the main causes of secondary bladder diverticula formation.

　　Clinically, diverticula are most common near the ureteral orifice. Embryologically, the bladder wall is different from the bladder trigone area, and it is currently believed that the weak connection between the trigone and the detrusor muscle is related to the formation of bladder diverticula.

　　Bladder diverticula can also occur at the blind end of the ureteral orifice. Oriasa (1990) reported 2 cases of ureteral orifice blind end causing ureteral and bladder diverticula.

　　Another type of bladder diverticulum is located at the neck, which may be related to incomplete absorption of the urachus, and is often secondary to lower urinary tract obstruction or prune-belly syndrome.

　　2. Pathogenesis

　　Congenital diverticula are often caused by redundant ureteral buds, unobstructed umbilical urachus, and congenital localized thinning of the bladder wall, with diverticula mostly solitary, containing the full thickness of the bladder wall, more common in children, and without lower urinary tract obstruction. Bladder diverticula can also be caused by secondary factors, often due to lower urinary tract obstruction, and the bladder wall splits from the detrusor muscle bundles to form diverticula, often multiple, with mucosal papillae (such as diverticula, which do not contain all layers of the bladder wall, are also called pseudodiverticula), more common in adult males, and associated with detrusor hyperplasia.

　　Cystitis cystica is often located at the bottom and sides of the bladder, with thin walls. If secondary infection occurs, symptoms such as urinary pain, frequent urination, and urgency may occur. If not treated in time, it can also lead to the following diseases:

　　1. It can cause poor urine drainage, easily accompany with vesicoureteral reflux, causing unilateral or bilateral hydronephrosis, eventually leading to renal failure.

　　2. Some patients may have hematuria due to stones in the diverticula.

　　3. A few patients may have urinary retention due to the large diverticula located behind the bladder neck, compressing the bladder outlet, causing constipation by compressing the rectum, and dystocia by compressing the uterus.

　　4. Due to the ascending inflammation, it can cause urinary tract infection.

　　Cystitis cystica is often caused by secondary infection of bladder diverticula. Symptoms may include difficulty urinating, frequent urination, urgency, and urinary tract infection symptoms. Some diverticula can be as large as 2000ml, compressing the bladder neck and urethra, leading to lower urinary tract obstruction. The diverticula have no contractile force, which causes poor urine drainage, and is prone to accompany with vesicoureteral reflux, which can cause unilateral or bilateral hydronephrosis, eventually leading to renal failure. However, there are also congenital giant diverticula that do not cause urinary tract obstruction. Due to the lack of muscle fibers in the bladder diverticula wall, urine cannot be drained from the giant diverticula during urination, causing symptoms of secondary urination. Some patients may have hematuria due to infection or stones in the diverticula, and a few patients may have urinary retention due to the large diverticula located behind the bladder neck, compressing the bladder outlet, causing constipation by compressing the rectum, and dystocia by compressing the uterus.

　　Firstly, it is important to maintain the cleanliness and hygiene of the genital area. Change underwear frequently, keep clean, drink more water in daily life, and drinking more water is one of the secrets to prevent secondary infection of cystitis cystica.

　　1. Do not use fragrant bath products, as this may cause unnecessary chemical stimulation to the bladder lining.

　　2. People with multiple sexual partners or those who have just changed partners have a higher incidence rate, so they need to pay extra attention.

　　3. Immediately empty the urine from the bladder before and after sexual intercourse.

　　4. Overfatigue is also one of the causes of the disease.

　　5. Do not wear tight clothing, jeans, and other similar clothing.

　　6. Both partners should be thoroughly cleaned before and after sexual intercourse.

　　Cystitis cystica is often caused by secondary infection of bladder diverticula. Symptoms may include difficulty urinating, frequent urination, urgency, and urinary tract infection symptoms. The diagnosis of this disease requires the assistance of relevant examinations to be confirmed, and the specific examinations are as follows:

　　1. Laboratory examination:Blood count is normal, or there is a slight increase in white blood cells. Urinalysis white blood cell count (or platelet count) ≥10 cells/HP, may have red blood cells, but no casts; Gram staining of urine sediment smear, WBC ≥15-20 cells/HP; midstream urine culture, colony ≥108/L. Urinalysis often shows pyuria or bacteriuria, and sometimes gross hematuria or microscopic hematuria may be found. Urine culture can detect pathogenic bacteria.

　　2. Urinary tract imaging:It appears as an extravesical cystic shadow with a neck connected to the bladder.

　　3. Ultrasound manifestations:Show a cystic or spherical liquid dark area connected to the side or posterior wall of the bladder, with enhanced echo of the posterior wall.

　　4. CT manifestations:Enhanced scanning shows an extravesical saccular shadow filled with contrast medium. If there is a stone or tumor in the diverticulum, there may be a filling defect.

　　The diet of patients with bladder diverticulum inflammation should pay attention to the following points:

　　1. Eat more diuretic foods, such as watermelons, grapes, pineapples, celery, pears, etc.

　　2. Snails, corn, mung beans, and scallion whites can help alleviate symptoms such as frequent urination, urgency, and dysuria.

　　3. Drink plenty of water to maintain a daily urine output of at least 1500 milliliters or more.

　　4. Avoid eating sour and spicy刺激性 food, such as strong alcohol, chili, original vinegar, sour fruits, etc.

　　5. Avoid eating citrus fruits because they can cause alkaline urine, which is conducive to bacterial growth.

　　6. Caffeine can cause bladder neck contraction and lead to spasmodic pain in the bladder, so coffee should be drunk less.

　　Cystitis of the bladder diverticulum can cause symptoms such as difficulty in urination, frequent urination, urgency, and urinary tract infection. The main treatment for this disease is to relieve lower urinary tract obstruction, control infection, and commonly used drugs include third-generation cephalosporins, fluoroquinolones, and metronidazole.

　　Currently, it is inclined to perform transurethral diverticulum neck incision first to drain the urine inside the diverticulum. If the effect is not good, consider open or laparoscopic diverticulectomy. If the diverticulum is large, the ureteral orifice is close to the diverticulum, or there is an opening in the diverticulum, it is necessary to perform diverticulectomy and anti-reflux bladder ureteral reimplantation surgery, and pay attention to repairing the muscle defect of the bladder ureteral orifice. Small diverticula do not need to be resected.