巨大膀胱憩室造成壓力沉沒效應於表現反覆急性尿滯留的懷孕女性

黃國倫¹、吳俊賢^1、2、林嘉祥^1、2

¹義大醫療財團法人義大醫院 泌尿科；

²義守大學 醫學系

Giant bladder diverticulum causing “pressure sink effect” in a pregnant woman with recurrent acute urinary retention
Allen, Guo-Lun Huang¹, Chun-Hsien Wu^1,2, Victor C. Lin^1,2

Department of Urology¹, E-Da Hospital, Kaohsiung, Taiwan;

School of Medicine, College of Medicine², I-Shou University, Kaohsiung, Taiwan

Introduction: A bladder diverticulum is a herniation of the bladder urothelium through the muscularis propria of bladder wall. It could be classified as congenital or acquired according to its etiologies. Most acquired bladder diverticula occur in adult males and are believed to originate secondary to bladder outlet obstruction (BOO). A giant bladder diverticulum may cause a “pressure sink effect”, which offsets the voiding pressure produced by detrusor muscle contraction when the urine flows from bladder into the diverticulum during urination. Herein we present a rare case of giant bladder diverticulum with “pressure sink effect” in a pregnant woman with recurrent acute urinary retention (AUR). The serial video-urodynamic studies (VUDS) confirm the etiology of giant bladder diverticulum to be female BOO.

Case report: A 31-year-old pregnant woman presented to the urology clinic with recurrent AUR and an indwelling urinary catheter at the gestational age of 8 weeks. The preceding symptoms included incomplete bladder emptying and dysuria for several years. Her personal and family history was unremarkable. Catheter-associated urinary trat infection (UTI) with multiple drug-resistant bacterial colonization was detected by urine culture. A bladder sonography revealed a suspicious bladder diverticulum over right lateral wall. Neither cystoscopy nor radiological evaluations were performed during her pregnancy. We instructed her to conduct clean intermittent self-catheterization 4 times per day, with occasional afebrile UTI episodes before delivery. A VUDS was arranged post-partum, and a huge bladder diverticulum with prominent “pressure sink effect”, i.e., urine inside the bladder empties into the diverticulum instead of urinating from the urethra, was detected by cinefluoroscopy. No detrusor contracting activity was observed during the voiding phase of the pressure flow study. She received laparoscopic bladder diverticulectomy smoothly and could urinate with acceptable post-voiding residual urine amount post-operatively. A follow-up VUDS three months after diverticulectomy showed a high voiding pressure & low flow rate pattern with non-funneling of bladder neck during urination. Primary bladder neck obstruction (PBNO) causing female BOO complicated with a giant bladder diverticulum was confirmed.

Conclusion: We demonstrated a young female with giant bladder diverticulum secondary to PBNO. Our case highlights the crucial role of VUDS in diagnosing female BOO, especially females with anatomical abnormalities of lower urinary tract.