SBA Questions
Justin C. Konje in Complete Revision Guide for MRCOG Part 2, 2019
A 53-year-old woman presents with urgency, frequency and haematuria. On examination, she is found to have an anterior hard 3 mm bulge, which is approximately 2 cm from the inside of the introitus. What single investigation will you undertake to confirm the diagnosis of urethral diverticulum?Examination under anaesthesiaNinety (90)-degree endoscopySixty (60)-degree endoscopyThirty (30)-degree endoscopyZero-degree endoscopy
Surgery to improve reservoir function
Jacques Corcos, David Ginsberg, Gilles Karsenty in Textbook of the Neurogenic Bladder, 2015
The bladder anterior wall and dome are approached, and the peritoneum is freed from the bladder until about halfway down the bladder posterior wall. The bladder is filled to about 200 ml, and a circular section of the detrusor muscle with a radius of about 4 cm around the urachus is resected. The mucosa is left intact (Figures 48.6 and 48.7). The diverticulum created in this way will reduce storage pressure and improve bladder capacity after a period of 1–2 years. An indwelling catheter is left for 2 days when the mucosa has not been perforated during the procedure. When mucosal perforation has occurred, the indwelling catheter is placed for a maximum of 2 weeks and is clamped intermittently for 3–4 days, putting a low-grade load on the diverticulum.5,24 In a few patients, adjunctive injection with botulinum A toxin to accelerate the process of functional transformation has shown partial success.
Cystourethroscopy
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
The visualization of a ureterocele is optimal when the bladder is not overly distended. With a full bladder, the ureterocele can efface and flatten, making it difficult to incise effectively. If there is a deficiency of bladder muscle backing at the site of the ureterocele, it will evert, making it look like a diverticulum. If the child is ill with urosepsis, a large transverse incision for definitive decompression is the primary goal, even if it results in secondary reflux. In the absence of clinical infection, a more limited incision or multiple punctures (like a “watering can”) can lead to effective decompression while minimizing the risk of secondary reflux.
Robotic bladder diverticulectomy: step-by-step extravesical posterior approach – technique and outcomes
Published in Scandinavian Journal of Urology, 2018
Giovanni Cacciamani, Nicolò De Luyk, Vincenzo De Marco, Marco Sebben, Leonardo Bizzotto, Davide De Marchi, Maria Angela Cerruto, Salvatore Siracusano, Antonio Benito Porcaro, Walter Artibani
A bladder diverticulum (BD) is an outpouching of the bladder through a defect in the bladder wall. A BD can be classified as congenital or acquired. The latter are more common in older patients with benign prostatic obstruction or urethral stricture. Clinically significant BD in men are uncommon. BD contain only scattered muscle fibres and this results in high residual urine volume that causes refractory lower urinary tract symptoms (LUTS), urinary infection, bladder calculi, ureteral ‘ab extrinseco’ obstruction or cancer in diverticulum [1]. BD may undergo neoplastic changes in 1–10% of cases [2]. The increased risk of bladder cancer in diverticula has been attributed to urinary stasis and to chronic inflammation [3]. A surgical approach is needed to relieve symptoms. Several surgical options for the correction of BD have been described, including open (with extravesical or intravesical approaches, or both), endoscopic (fulguration, BD neck resection) and laparoscopic (extraperitoneal, intraperitoneal or transvesical approaches) procedures [4]. Within the past few years, robotic surgery has been suggested as another possible approach. This article reports the authors’ preliminary experience of robot-assisted bladder diverticulectomy (RBD) using the da Vinci SI® Surgical System, describing surgical technique, perioperative management and outcomes.
Urinary bladder rupture years after excision of urachal remnant
Published in Baylor University Medical Center Proceedings, 2020
Zoe Blumenthal, Kim H. Thai, Faris Hashim, Jeffrey Waxman, Marawan M. El Tayeb
Spontaneous urinary bladder rupture is a rare yet life-threatening clinical phenomenon. In the absence of trauma, spontaneous bladder rupture has been associated with pelvic malignancy, vaginal delivery, bladder infections, radiation therapy, congenital genitourinary malformations, bladder augmentation surgery, neurogenic bladder, urinary retention, and benzodiazepine overdose.1–4 In the pediatric population, the leading causes of rupture in reported cases are neurogenic bladders, bladder diverticulum, bladder outlet obstruction, and history of bladder augmentation surgery.3 Patients with a ruptured bladder typically present with abdominal pain, distension, dysuria, and decreased urinary output.5 Nontraumatic rupture has mortality rates approaching 50%.1
The effects of hysteroscopy and laparoscopy for scar diverticulum resection and suture on blood loss, operation time and antibiotic time
Published in Journal of Obstetrics and Gynaecology, 2022
Weifeng Li, Tiecheng Lin, Yong Xie, Lijiang Xu, Yangping Chen, Yuyuan Zhu, Xia Dong, Pei Cheng, Chunxiang Duan
Uterine scar diverticulum (CSD) after caesarean section, also called postoperative uterine incision defect (PCSD), is caused by poor healing of the uterine incision after caesarean section, manifested as thinning of the muscle layer at the incision of the uterine scar. The depression or cavity in communication with the uterine cavity will then cause abnormal vaginal bleeding, pelvic pain and other related clinical symptoms (Minovi et al. 2015; Zhao et al. 2019). Uterine diverticulum is divided into congenital and acquired diverticulum. Congenital diverticulum is related to abnormal embryonic development. Acquired diverticulum is also called false diverticulum. Uterine incision diverticulum after caesarean section is an acquired diverticulum. In recent years, with the increase of caesarean section, acquired uterine diverticulum has gradually increased. Patients with uterine diverticulum often present with prolonged menstrual period, inexhaustible vaginal bleeding, and pregnancy in the diverticulum. Its treatment included drugs and surgery. At present, there is no unified understanding of the effects of various treatment methods, and a unified treatment standard has not been formed. This study intends to investigate the role of transvaginal CSD electro resection and suture guided by hysteroscopy in the treatment of CSD.
Related Knowledge Centers
- Embryology
- Thyroid Diverticulum
- Tongue
- Submucosa
- Mucous Membrane
- Zenker'S Diverticulum
- Muscular Layer
- Adventitia
- Meckel'S Diverticulum
- Kidney