Surgical treatment of a true diverticulum of the bladder in a patient with aplasia of the left kidney. Case report

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Abstract

A bladder diverticulum (BD) is a blindly terminating sac-like protrusion of the bladder wall with or without involvement of the muscular layer. BDs are categorized into true (congenital) and false (acquired), single and multiple. False diverticula are more common and develop in infravesical obstruction due to urethral stricture, prostate neoplasms, neurogenic disorders and other lower urinary tract diseases. Currently, there are no clear recommendations regarding the tactics of treatment of BD, so the choice of treatment method is based on the determination of the cause of BD, assessment of clinical manifestations and diagnostic results (localization, size, number, etc.), as well as the identification of concomitant anomalies and diseases of the upper urinary tract. The priority in the treatment of BD is surgical treatment. The article presents the observation of a patient with a developmental anomaly in the form of aplasia of the left kidney combined with a large congenital BD in the area of the missing mouth of the aplasic left ureter. The results of examination and treatment in the form of laparoscopic diverticulectomy are presented. A brief review of the literature on the problem of diverticulosis has been carried out.

About the authors

Vladimir V. Protoshak

Kirov Military Medical Academy

Email: protoshakurology@mail.ru
ORCID iD: 0000-0002-4996-2927
SPIN-code: 6289-4250

D. Sci. (Med.), Prof.

Russian Federation, Saint Petersburg

Nikolai Y. Iglovikov

Kirov Military Medical Academy

Author for correspondence.
Email: iglovikov@yandex.ru
ORCID iD: 0009-0006-2027-9573

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Nikolay P. Kushnirenko

Kirov Military Medical Academy

Email: nikolaj.kushnirenko@yandex.ru
ORCID iD: 0009-0004-1960-4696
SPIN-code: 3892-8959

D. Sci. (Med.)

Russian Federation, Saint Petersburg

Nikolay N. Haritonov

Kirov Military Medical Academy

Email: nnharitonov@mail.ru
ORCID iD: 0009-0005-9340-4470

Cand. Sci. (Med.)

Russian Federation, Saint Petersburg

Vasily K. Karandashov

Kirov Military Medical Academy

Email: karandashov_vk@mail.ru
ORCID iD: 0009-0001-5155-9491

oncologist

Russian Federation, Saint Petersburg

Sergei M. Gozalishvili

Kirov Military Medical Academy

Email: gozalishwili@mail.ru
SPIN-code: 8838-2460

oncologist

Russian Federation, Saint Petersburg

Radjab M. Mukhtarov

Kirov Military Medical Academy

Email: muhtarov007spb@mail.ru
ORCID iD: 0009-0009-3434-0592

Clinical Resident

Russian Federation, Saint Petersburg

References

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  2. Benchekroun A, Belahnech Z, Faik M, et al. Utérus didelphe, hémivagin borgne, agénésie rénale avec diverticule urétéral, homolatéral droit à abouchement ectopique vulvaire et hypospadias féminin [Didelphic uterus, blind hemi-vagina, renal agenesia with right, homolateral ureteral diverticulum with ectopic opening into the vulva and female hypospadias]. Prog Urol. 1991;1(4):600-5 (in French).
  3. Айвазян А.В., Войно-Ясенецкий А.М. Пороки развития почек и мочеточников. М.: Наука, 1988 [Aivazian AV, Voino-Iasenetskii AM. Poroki razvitiia pochek i mochetochnikov. Moscow: Nauka, 1988 (in Russian)].
  4. Сиваков А.А., Протощак В.В., Гозалишвили С.М., и др. Диагностика и лечение дивертикулов мочевого пузыря. Урологические ведомости. 2023;13(2):177-85 [Sivakov AA, Protoshchak VV, Gozalishvili SM, et al. Diagnostics and treatment of bladder diverticula. Urology reports (St.-Petersburg). 2023;13(2):177-85 (in Russian)]. doi: 10.17816/uroved508768
  5. Pham KN, Jeldres C, Hefty T, Corman JM. Endoscopic Management of Bladder Diverticula. Rev Urol. 2016;18(2):114-7. doi: 10.3909/riu0701
  6. Thüroff JW, Roos FC, Thomas C, et al. Surgery illustrated – surgical Atlas: Robot-assisted laparoscopic bladder diverticulectomy. BJU Int. 2012;110(11):1820-36. doi: 10.1111/j.1464-410X.2012.11576.x
  7. Halaseh SA, Leslie SW. Bladder Diverticulum. In: StatPearls [Internet]. 2023. Treasure Island (FL): StatPearls Publishing. 2024

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2. Fig. 1. Schematic representation of the formation of the secondary kidney.

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3. Fig. 2. Patient V., ultrasound of the urinary bladder. The arrow indicates the DMP.

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4. Fig. 3. Patient V., computed tomography of the abdomen and pelvis: a – aplasia of the left kidney, DMP; b – DMP.

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5. Fig. 4. Patient V., 3D reconstruction of aplasia of the left kidney and left ureter.

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6. Fig. 5. Patient V., micturition cystogram, DMP.

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7. Fig. 6. Patient V., fibrourethrocystodiverticuloscopy: a – orifice of the VSD; b – wall of the VSD.

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8. Fig. 7. Patient V., macropreparation of the DMP after surgical treatment in the amount of laparoscopic diverticulectomy.

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9. Fig. 8. Patient V., cystogram on the 8th day after laparoscopic diverticulectomy (no leaks).

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