Primary congenital bladder diverticula in children

Abstract

Objectives: To present the symptoms, treatment, evolution, and pathologic findings of primary (nonobstructive) diverticula in childhood. Primary (nonobstructive) diverticula are not frequent in childhood. Bladder diverticula have classically been defined as "hernias of the mucosa through muscular fibers of the bladder wall."

Methods: From September 1985 through September 2005, we treated 11 children categorized has having primary congenital bladder diverticula. At diagnosis, their ages ranged between 7 months and 9 years (mean 4.6 years). Ten were boys and one was a girl. The main reason for consultation was febrile urinary infection (n = 5), recurrent urinary infections (n = 3), enuretic syndrome (n = 1), gross hematuria (n = 1), and pain in the right iliac fossa (n = 1). One child had Ehlers-Danlos syndrome. All the diverticula were larger than 2 cm in diameter. Of the 11 children, 10 underwent surgery. Clinical observation was chosen for the 9-month-old infant.

Results: All 10 operated children had developed favorably at a follow-up of 2 to 20 years (mean 9.3). The 9-month-old child continued under observation for 5 years. We observed no diverticulum recurrence and no postoperative vesicoureteral reflux in the reimplanted children. Pathologic examination was performed of the excised diverticula in 7 cases, and muscular fibers were found in all of them; however, most of the fibers were very fine, particularly at the dome of the diverticulum.

Conclusions: The results of our study have shown that urinary tract infection is the most common symptom of bladder diverticula. Surgical treatment provided good results, without any recurrence or morbidity. The bladder diverticula were lined with fine muscular fibers.