Introduction
Bladder diverticulum is herniation of the bladder mucosa and submucosa through bladder wall with multifactorial causes that can either be acquired or be congenital. It often has no symptom and is diagnosed by chance during examination for other reason, but it sometimes leads to various urinary symptoms, such as urinary difficulty, retention, hesitancy, etc. We incidentally found the bladder diverticulum in stroke patient with new-onset urinary symptoms.
Case reports
A 79-year-old male with acute lateral medullary infarction complained new-onset urinary difficulty, frequency, and retention after voiding from three days after stroke. He has had mild benign prostatic hyperplasia (BPH) and were taking medicine for 6 years without any urinary symptom. More than 100 ml of residual urine after voiding was checked with the feeling of retention, the difficulties in initiation, and also the frequency. Urology consultation and adding medication did not help him. We conducted the voiding cystourethrography (VCUG) and found two round spaces filled with dye. Computerized tomography (CT) was, then, done and confirmed one of the two as a diverticulum on the upper right side of the true bladder. He underwent diverticulectomy and after 2 weeks of foley catheter, his urinary symptoms disappeared. VCUG was performed again after the surgery and had non-specific findings, except the trabeculation of the wall.
Discussion
Bladder diverticulum is made and grown gradually during various urinary obstructive conditions and he, even had no symptom, had having BPH (one of the urinary obstructive conditions) for several years. So if neuropathic bladder was impressed in stroke patients with BPH, bladder diverticulum can be one of the causes of it. Neuropathic bladder was reported after lateral medullary infarction and in this case, stroke might aggravated his neuropathic bladder, so that the symptoms were expressed.
Conclusion
We report an incidental bladder diverticulum in stroke patient with BPH who complained new-onset urinary symptoms.
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