巨大膀胱憩室の2例

Abstract

Two rare cases of giant vesical diverticulum without infravesical obstruction in female are presented. The first case, a 58-year-old female, was admitted because of diverticulum with continuous urinary infection, which was diagnosed by urological examinations for hematuria. The second case, a 58-year-old female, was admitted with the diagnosis of diverticulum, which was done by the gynecologist during laparotomy for the suspicion of a right ovarian cyst. Neither patient complained of difficulty in urination in spite of remarkable residual urine and no neurologic abnormalities were detected. The cystograms of the two cases revealed over-goose-egg sized diverticula and vesical capacity was over 800 ml, in both cases. The other urograms and endoscopy showed no evidence of vesical trabeculation or any obstructive changes of bladder neck or urethra in either case. Therefore, mucosal diverticulectomy in the first and total diverticulectomy in the second, was performed for the residual urine. Each surgical specimen showed the muscle layer of the walls. In the post-operative course, urination was improved in spite of the underactive detrusor pattern of the cystometry in the first case. But residual urine volume was not decreased after the operation in the second case. These two cases seem to be congenital vesical diverticulum. But it is hard to rule out the possibility of secondary diverticulum due to neurogenic disorders of urinary bladder.