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ACUTE URINARY RETENTION DUE TO AN IATROGENIC BLADDER DIVERTICULUM
0022-5347/97/1585-1907$03.00/0
Vol. 158,1907, November 1997 Printed in U S A
THE JOURNAL OF UROLOGY
Copyright 0 1997 by AMERICANU R O ~ I CASSCIATION, AL INC
ACUTE URINARY RETENTION DUE TO AN IATROGENIC BLADDER DIVERTICULUM JAVIER HERNhJDEZ, ROBERT L. WAGUESPACK, MATTHEW HORTON AND THOMAS A. ROZANSKI From the Urology Surgery Service and Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas
KEY WORDS: urinary retention, bladder, diverticulum, laparompy Acute urinary retention due to bladder diverticula is a rare event.' We report a case of an unusual bladder diverticulum aRer recurrent episodes of acute urinary retention. The possibility of a n iatrogenic laparoscopic etiology of the lesion is discussed. CASE REPORT
A 27-year-old man was referred to our institution after 3 episodes of acute urinary retention during a 6-month period. With each episode of urinary retention the patient reported mid abdominal pain, catheterization yielded greater than 400 cc of urine and he was able to void normally without discomfort following drainage. The patient denied any other genitourinary problems. History was remarkable only for left inguinal herniorrhaphy at age 17 years and laparoscopic repair of a recurrent left inguinal hernia 8 years later. All FIG. 2. Diverticulum histology. Reduced from ~ 4 0
Accepted for publication March 21, 1997. The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Departments of the Army, Air Force or Defense.
episodes of urinary retention occurred subsequent to laparosCOPY. Radiological evaluation demonstrated a large diverticulum to the left of the midline near the bladder dome (fig. 1). Cystoscopic examination revealed an ostium on the left posterior bladder. The wall of the diverticulum was so thin that intraperitoneal fat was visible through it. At surgical exploration, the diverticulum was found to be adherent to the peritoneum and omentum. The lesion was not associated with the urachal structure or remnant. The diverticulum was resected and the bladder was closed in 2 layers. Histological examination of the specimen revealed benign transitional epithelium, thinning in some areas to 2 cell layers of benign cuboidal epithelium lacking smooth muscle (fig.2). COMMENTS
There are only 3 previous reports of urinary retention as a result of bladder diverticula.' In our case it is likely that symptoms were due to vesicodiverticular reflw of urine and over distension of the diverticulum. The location of the lesion and onset of symptoms following surgery suggest an unrecognized iatrogenic laparoscopic injury. Bladder injury during laparoscopy has been reported previously.2.3 To our knowledge we report the first acquired diverticulum secondary to laparoscopic injury. We postulate that the lesion became clinically apparent with time and repeated distension. REFERENCES
FIG. 1. Diverticulum to leR of bladder dome. Note hernia clips in
leR inguinal area.
1907
1. Jarow, J. P.and Brendler, C. B.: Urinary retention caused by a large bladder diverticulum: a simple method of diverticulectomy. J. Urol., 139 1260,1988. 2. Gregory, F. M., Fetterman, H. H. and Chefetz, M.: Complications of laparoscopy: two cases of perforated urinary bladder. Amer. J. Obst. Gynec., 120 1121,1974. 3. Homburg, R. and Segal,T.: Perforation of the urinary bladder by the laparoscope. Amer. J. Obst. Gynec., 130: 597, 1978.
Vol. 158,1907, November 1997 Printed in U S A
THE JOURNAL OF UROLOGY
Copyright 0 1997 by AMERICANU R O ~ I CASSCIATION, AL INC
ACUTE URINARY RETENTION DUE TO AN IATROGENIC BLADDER DIVERTICULUM JAVIER HERNhJDEZ, ROBERT L. WAGUESPACK, MATTHEW HORTON AND THOMAS A. ROZANSKI From the Urology Surgery Service and Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, Texas
KEY WORDS: urinary retention, bladder, diverticulum, laparompy Acute urinary retention due to bladder diverticula is a rare event.' We report a case of an unusual bladder diverticulum aRer recurrent episodes of acute urinary retention. The possibility of a n iatrogenic laparoscopic etiology of the lesion is discussed. CASE REPORT
A 27-year-old man was referred to our institution after 3 episodes of acute urinary retention during a 6-month period. With each episode of urinary retention the patient reported mid abdominal pain, catheterization yielded greater than 400 cc of urine and he was able to void normally without discomfort following drainage. The patient denied any other genitourinary problems. History was remarkable only for left inguinal herniorrhaphy at age 17 years and laparoscopic repair of a recurrent left inguinal hernia 8 years later. All FIG. 2. Diverticulum histology. Reduced from ~ 4 0
Accepted for publication March 21, 1997. The opinions or assertions contained herein are the private views of the authors and are not to be construed as reflecting the views of the Departments of the Army, Air Force or Defense.
episodes of urinary retention occurred subsequent to laparosCOPY. Radiological evaluation demonstrated a large diverticulum to the left of the midline near the bladder dome (fig. 1). Cystoscopic examination revealed an ostium on the left posterior bladder. The wall of the diverticulum was so thin that intraperitoneal fat was visible through it. At surgical exploration, the diverticulum was found to be adherent to the peritoneum and omentum. The lesion was not associated with the urachal structure or remnant. The diverticulum was resected and the bladder was closed in 2 layers. Histological examination of the specimen revealed benign transitional epithelium, thinning in some areas to 2 cell layers of benign cuboidal epithelium lacking smooth muscle (fig.2). COMMENTS
There are only 3 previous reports of urinary retention as a result of bladder diverticula.' In our case it is likely that symptoms were due to vesicodiverticular reflw of urine and over distension of the diverticulum. The location of the lesion and onset of symptoms following surgery suggest an unrecognized iatrogenic laparoscopic injury. Bladder injury during laparoscopy has been reported previously.2.3 To our knowledge we report the first acquired diverticulum secondary to laparoscopic injury. We postulate that the lesion became clinically apparent with time and repeated distension. REFERENCES
FIG. 1. Diverticulum to leR of bladder dome. Note hernia clips in
leR inguinal area.
1907
1. Jarow, J. P.and Brendler, C. B.: Urinary retention caused by a large bladder diverticulum: a simple method of diverticulectomy. J. Urol., 139 1260,1988. 2. Gregory, F. M., Fetterman, H. H. and Chefetz, M.: Complications of laparoscopy: two cases of perforated urinary bladder. Amer. J. Obst. Gynec., 120 1121,1974. 3. Homburg, R. and Segal,T.: Perforation of the urinary bladder by the laparoscope. Amer. J. Obst. Gynec., 130: 597, 1978.