案例報告：高尿流速患者與巨大膀胱憩室

楊迪媛^{1, 2}, 林文州^{1, 2}

¹馬偕紀念醫院泌尿科, ²馬偕醫學院

Ti-yuan Yang^{1, 2}, Wen-Chou Lin^{1, 2}

¹Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan

²Department of Medicine, Mackay Medical College, Taipei, Taiwan

Bladder diverticulum is a herniation of the bladder mucosa through the muscularis propria of bladder wall. We report a case of super voider with giant bladder diverticulum.

A 65-year-old man presented to the gastroenterology outpatients department with complaints of upper abdominal pain for 3-4 months. Abdominal echo showed intra-abdominal loculated cystic lesions liver. Abdominal CT showed a dumbbell shaped huge cystic lesion about 13.8 x 25.8 x 28.9 in size with upward displacement of bowel loops. Possible originated form or adjacent to prostate gland. Bilateral kidneys are grossly unremarkable, no hydronephrosis nor hydroureter. The urinary bladder is poorly demonstrated in the CT study. Blood exam showed normal renal function. Thus, the patient was transferred to urology outpatients department. Digital rectal examination revealed an mild enlarged prostate with elastic consistency. Transrectal ultrasonography showed prostate gland volume was 31.6 cm3. Uroflowmetry showed a peak flow rate of 42.8 mL/s on voiding 1146 mL urine. Due to intra-abdominal cystic lesions, residual urine cannot measured by ultrasonography. Urethral catheterization drained 4000ml urine and led to improvement of abdominal distension and pain. Cystoscopy confirmed the presence of a diverticulum in the left lateral wall of the bladder. A left side double-J ureteral stent was placed. Open diverticulectomy through a midline incision were done. Postoperative course was uneventful.