Acute urinary retention in an infant: an unusual presentation of a paraureteral diverticulum

Three rare etiologies of urinary retention in pediatrics: A case series and review of the literature

Etiology of urinary retention in pediatric age differs significantly from adults and the elderly. Therefore, a comprehensive diagnosis is crucial before specific treatment. Every effort must be made to minimize invasive procedures as far as possible in children.

A bladder stone within a congenital paraureteral diverticulum: a case report

Paraureteral diverticula are rare in pediatric population. We here present a bladder stone in the congenital paraureteral diverticulum presenting with vesicoureteral reflux. To the best of our knowledge, stone formation in paraureteral diverticulum has not been reported previously. A 5-year-old boy was admitted with the complaint of dysuria. Abdominal ultrasonography revealed a bladder stone in a diverticulum arising from right posterolateral wall and a small right kidney. Voiding cystourethrogram confirmed large bladder diverticulum with vesicoureteral reflux. Cystoscopy revealed a giant stone in the paraureteral diverticulum. The stone was removed with open diverticulectomy and right Cohen ureteroneocystostomy was performed.

Extravesical diverticuloplasty for repair of a paraureteral diverticulum and the associated refluxing ureter

PURPOSE

Extravesical diverticuloplasty for repairing a paraureteral (Hutch) diverticulum and the related refluxing ureter is presented.

MATERIALS AND METHODS

Of the 16 children in this study 10 had bilateral paraureteral diverticula with associated bilateral vesicoureteral reflux, 2 had bilateral paraureteral diverticula with a bilateral duplicated ureter, unilateral duplex refluxing ureters and contralateral lower moiety vesicoureteral reflux, and 4 had a unilateral paraureteral diverticulum with an ipsilateral refluxing ureter. The anatomical relationship of the ureteral orifice and diverticulum was identified by cystourethroscopy preoperatively and confirmed during the extravesical operation. The surgical technique differed depending on the size of the diverticulum and the position of the ureteral opening when the bladder was completely distended. The larger prolapsed diverticular mucosa served as a backing for the detrusor muscle, which was closed over the ureter, and the smaller diverticulum was repaired as a dilated ureter. Overall 30 renal units with grades II to IV vesicoureteral reflux were corrected by this method.

RESULTS

All patients were followed with ultrasound and voiding cystourethrography 3 and 9 months postoperatively. The diverticula with associated refluxing ureters were successfully cured. Neither postoperative recurrence nor ureteral obstruction were noted.

CONCLUSIONS

Extravesical diverticuloplasty can be performed for many sizes of paraureteral diverticula and concomitantly for the associated refluxing ureter, including refluxing duplex ureters.