Pediatric Surgery for Bladder Anomalies Workup

  • Chief Editor: Marc Cendron, MD   more...
 
Updated: Jan 25, 2010
 

Laboratory Studies

  • Bladder diverticula - None
  • Urachal sinus - None
  • Urachal cyst - None
  • Patent urachus - Analysis of the umbilical drainage for creatinine or urea to determine if the values are consistent with urine may help differentiate the patent urachus from other entities listed in the differential diagnosis.
  • Vesicourachal diverticulum - None
  • Bladder ears - None
  • Bladder agenesis - Serum electrolytes, creatinine
  • Megacystitis - Urine culture, serum creatinine
  • Bladder duplication - Urine culture, serum creatinine
  • Bladder septation - Urine culture, serum creatinine
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Imaging Studies

  • Bladder diverticula: VCUG is the best imaging modality. Bladder ultrasonography may also be used to detect bladder diverticula but does not provide the same anatomic definition as the VCUG. IVP may detect bladder diverticula, particularly those that protrude laterally. Anteriorly or posteriorly placed diverticula may be obscured from view because they are overshadowed by the contrast within the bladder.Voiding cystourethrogram showing a bladder divertiVoiding cystourethrogram showing a bladder diverticulum arising from the posterior aspect of the bladder. Voiding cystourethrogram showing 2 posteriorly plaVoiding cystourethrogram showing 2 posteriorly placed bladder diverticula. Bladder ultrasound showing 2 posteriorly placed blBladder ultrasound showing 2 posteriorly placed bladder diverticula.
  • Urachal sinus: Sinography is the best test to detect urachal sinus. Other less sensitive tests include ultrasonography, computed axial tomography (CT) scanning, or magnetic resonance imaging (MRI).[14]
  • Urachal cyst: Ultrasonography is the best test for detecting urachal cyst. CT scanning or MRI can help to delineate the size and location of the cyst. In addition, with infected urachal cysts, CT scanning is used to determine involvement of adjacent structures secondary to the inflammatory mass.[14] Duplicated bladder with a urethral catheter placedDuplicated bladder with a urethral catheter placed into each bladder. Voiding cystourethrogram demonstrating a duplicateVoiding cystourethrogram demonstrating a duplicated bladder.
  • Patent urachus: VCUG may demonstrate a patent urachus in addition to identifying any evidence of bladder outlet obstruction or vesicoureteral reflux.
  • Vesicourachal diverticulum: VCUG is the most useful test. This test is used to identify any evidence of bladder outlet obstruction or vesicoureteral reflux.
  • Bladder ears: This anomaly can be incidentally discovered with VCUG or IVP.
  • Bladder agenesis: Full evaluation is best performed with IVP and VCUG. These 2 tests delineate both upper tract and lower tract anatomy.
  • Megacystitis: VCUG is the best test to demonstrate the enlarged bladder and massive refluxing megaureters. Additional studies, such as nuclear medicine renal scanning, are helpful in determining renal function. Cystography and urodynamic studies may be necessary in those children with voiding dysfunction such as incomplete bladder emptying, frequent cystitis, or incontinence.Intravenous pyelogram demonstrating a duplicated bIntravenous pyelogram demonstrating a duplicated bladder. Notice how each ureter drains into the ipsilateral bladder.
  • Bladder duplication: The full evaluation is best performed with IVP and VCUG. These 2 tests delineate both upper tract and lower tract anatomy.Urachal cyst at the level of the umbilicus. Urachal cyst at the level of the umbilicus. Bladder anomalies. Ultrasound demonstrating urachaBladder anomalies. Ultrasound demonstrating urachal cyst. Ultrasound cursors mark the extent of the cyst. Voiding cystourethrogram showing megacystitis. BilVoiding cystourethrogram showing megacystitis. Bilateral vesicoureteral reflux is also observed (grade 3 on the right, grade 2 on the left).
  • Bladder septation: This condition may often require several imaging modalities, including VCUG, IVP, and bladder ultrasonography, to fully delineate the anatomy.
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Procedures

  • Infected urachal cyst: In some instances, percutaneous drainage of the infected cyst is necessary as a temporary measure. After percutaneous decompression and adequate antibiotic therapy, complete surgical excision of the urachus is necessary.
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Contributor Information and Disclosures
Coauthor(s)

Bartley G Cilento, Jr, MD  Instructor, Department of Surgery, Division of Urology, Children's Hospital of Boston and Harvard Medical School

Bartley G Cilento, Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, and Massachusetts Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Martin David Bomalaski, MD, FAAP  Pediatric Urologist, Alpine Urology

Martin David Bomalaski, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, and American Urological Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Harry P Koo, MD  Chairman of Urology Division and Director of Pediatric Urology, Virginia Commonwealth University; Professor of Surgery, VCU School of Medicine, Medical College of Virginia; Director of Urology, Children's Hospital of Richmond

Harry P Koo, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Surgeons, and American Urological Association

Disclosure: Nothing to disclose.

Paul D Petry, DO, FACOP, FAAP  Consulting Staff, Freeman Pediatric Care, Freeman Health System

Paul D Petry, DO, FACOP, FAAP is a member of the following medical societies: American Academy of Osteopathy, American Academy of Pediatrics, American College of Osteopathic Pediatricians, and American Osteopathic Association

Disclosure: Nothing to disclose.

Chief Editor

Marc Cendron, MD  Associate Professor of Surgery, Harvard School of Medicine; Consulting Staff, Department of Urological Surgery, Children's Hospital Boston

Marc Cendron, MD is a member of the following medical societies: American Academy of Pediatrics, American Urological Association, European Society for Paediatric Urology, Johns Hopkins Medical and Surgical Association, New Hampshire Medical Society, Society for Fetal Urology, and Society for Pediatric Urology

Disclosure: Nothing to disclose.

References

  1. Caldamone AA. Anomalies of the bladder and cloaca. In: Gillenwater JY, Grayhack JT, Howards SS, et al, eds. Adult and Pediatric Urology. 2nd ed. St. Louis, Mo: Mosby Year Book; 1987:2023.

  2. Cilento BG, Nguyen HT. Bladder diverticula, urachal anomalies, and other uncommon anomalies of the bladder. In: Gearhart JP, Rink RC, Mouriquand P, eds. Pediatric Urology. Philadelphia, Pa: WB Saunders; 2001.

  3. Tacciuoli M, Laurenti C, Racheli T. Double bladder with complete sagittal septum: diagnosis and treatment. Br J Urol. Dec 1975;47(6):645-9. [Medline].

  4. Coker AM, Allshouse MJ, Koyle MA. Complete duplication of bladder and urethra in a sagittal plane in a male infant: case report and literature review. J Pediatr Urol. Aug 2008;4(4):255-9. [Medline].

  5. Blane CE, Serin JM, Bloom DA. Bladder diverticula in children. Radiology. 1194;190:695. [Medline].

  6. Stephens FD. The vesicoureteral hiatus and paraureteral diverticula. J Urol. Jun 1979;121(6):786-91. [Medline].

  7. Pieretti RV, Pieretti-Vanmarcke RV. Congenital bladder diverticula in children. Journal of Pediatric Surgery. 1999;34:468. [Medline].

  8. Verghese M, Belman AB. Urinary retention secondary to congenital bladder diverticula in infants. J Urol. Dec 1984;132(6):1186-8. [Medline].

  9. Barrett DM, Malek RS. Observations on vesical diverticulum in childhood. Journal of Urology. 1976;116:234. [Medline].

  10. Burbige KA, Lebowitz RL, Colodny AH. The megacystis-megaureter syndrome. J Urol. Jun 1984;131(6):1133-6. [Medline].

  11. Levard G, Aigrain Y, Ferkadji L. Urinary bladder diverticula and the Ehlers-Danlos syndrome in children. J Pediatr Surg. Nov 1989;24(11):1184-6. [Medline].

  12. Burns E, Cummins H, Hyman J. Incomplete reduplication of the bladder. Journal of Urology. 1947;57:257.

  13. Shokeir AA, Ashamallah A, Abol-Enein H. Incomplete bladder duplication. Br J Urol. Jan 1995;75(1):106-7. [Medline].

  14. Cilento BG Jr, Bauer SB, Retik AB. Urachal anomalies: defining the best diagnostic modality. Urology. Jul 1998;52(1):120-2. [Medline].

  15. Powell CR, Kreder KJ. Treatment of bladder diverticula, impaired detrusor contractility, and low bladder compliance. Urol Clin North Am. Nov 2009;36(4):511-25, vii. [Medline].

  16. Yohannes P, Bruno T, Pathan M, Baltaro R. Laparoscopic radical excision of urachal sinus. J Endourol. Sep 2003;17(7):475-9; discussion 479. [Medline].

  17. Castillo OA, Vitagliano G, Olivares R, Sanchez-Salas R. Complete excision of urachal cyst by laparoscopic means: a new approach to an uncommon disorder. Arch Esp Urol. Jun 2007;60(5):607-11. [Medline].

  18. Chiarenza SF, Scarpa MG, D'Agostino S, Fabbro MA, Novek SJ, Musi L. Laparoscopic excision of urachal cyst in pediatric age: report of three cases and review of the literature. J Laparoendosc Adv Surg Tech A. Apr 2009;19 Suppl 1:S183-6. [Medline].

  19. Hutch JA. Saccule formation at the ureterovesical junction in smooth-walled bladders. Journal of Urology. 1961;86:390.

 
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Voiding cystourethrogram showing a bladder diverticulum arising from the posterior aspect of the bladder.
Voiding cystourethrogram showing 2 posteriorly placed bladder diverticula.
Bladder ultrasound showing 2 posteriorly placed bladder diverticula.
Duplicated bladder with a urethral catheter placed into each bladder.
Voiding cystourethrogram demonstrating a duplicated bladder.
Intravenous pyelogram demonstrating a duplicated bladder. Notice how each ureter drains into the ipsilateral bladder.
Urachal cyst at the level of the umbilicus.
Bladder anomalies. Ultrasound demonstrating urachal cyst. Ultrasound cursors mark the extent of the cyst.
Voiding cystourethrogram showing megacystitis. Bilateral vesicoureteral reflux is also observed (grade 3 on the right, grade 2 on the left).
 
 
 
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