Incont Pelvic Floor Dysfunct 2011; 5(2):43-45 Case analysis

Bladder Diverticula in a Young Woman — Congenital or Acquired?

Soo-Cheen Ng, M.D.1,2, Sung-Lang Chen, M.D.1,3, Gin-Den Chen, M.D.1,2
School of Medicine1, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology2, Urology3, Chung Shan Medical
University Hospital, Taichung, Taiwan

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Received: March 10, 2011 Accepted: April 6, 2011

Address correspondence to: Dr. Gin-Den Chen, Department of Obstetrics and Gynecology,
Chung Shan Medical University Hospital, 110, Section 1, Chien-Kuo North Road,
Taichung, Taiwan Fig. 2. Transvaginal sonography revealed urinary bladder with turbid urine,
E-mail: gdchentw@hotmail.com thick bladder wall and multiple cystic compartments.

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Case analysis

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Fig. 4. Post-operative voiding cystourethrogram: some tiny diverticula noted

especially at the bladder base, noted that no proximal or mid-urethral
dilatation during voiding phase.

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1. Garat JM, Angerri O, Caffaratti J, Moscatiello P, Villavicencio H:
Primary congenital bladdder diverticula in children. Urology 2007;
70:984-988.
2. Walsh PC: Campbell’s Urology 8th edition., Saunders, 2002, pp
2188-2189.
3. Jorion JL, Michel M: Spontaneous rupture of bladder diverticula in a
girl with Ehlers-Danlos Syndrome. J Pediatr Surg 1999; 34:483-
484.
4. Stein RJ, Matoka DJ, Noh PH, Docimo SG: Spontaneous perfora-
tion of congenital bladder diverticulum. Urology 2005; 66:881.
QR
Case analysis
5. Oge O, Gemalmaz H, Ozeren B: Acute urinary retention in a child
caused by a congenital bladder diverticulum. J Pediatr Surg 2002;
37:926-927.
6. Chang CC, Liu KL: Images in clinical medicine. Bladder diverticula.
N Engl J Med 2010; 363:e13.
7. Kuo HC: Spastic urethral sphincter and chronic urinary retention in
a girl. Incont Pelvic Floor Dysfunct 2009; 3:57.
8. Thiel DD, Young PR, Wehle MJ, Broderick GA, Petrou SP, Igel TC:
Robotic-assisted bladder diverticulectomy: Tips and tricks. Urology
2011; 77:1238-1242.