VESICAL DIVERTICULA IN CHILDREN

Abstract

Summary 1. Twenty‐three patients with diverticula of the bladder were treated during an eight‐year period at the Royal Children's Hospital, Melbourne. In 13 patients, the diverticulaco‐existed with proven urethral obstruction. In 10 patients the diverticula were not associated with an obstructive factor. These 10 patients and their diverticula are described in this paper. 2. The aetiological factor responsible for the formation of the diverticula unassociated with obstruction of the urethra, is a localized developmental muscular defect of the bladder wall. The diverticulum itself is a protrusion caused by the normal ranges of intra‐vesical pressure exerted on the bladder wall in the course of normal function. Two types of diverticula were identified‐the localized globular pocket with narrow neck, and the less common diffuse wide necked bulge of the lateral wall of the bladder. 3. The relationship between diverticula and the occurrence of vesico‐ureteral reflux is discussed. Reflux is related not to the proximity of the body of the diverticulum to the ureter wall nor to the size of the diverticulum but to the intimacy of their orifices. 4. The view is put forward that the anomaly of muscular development which results in diverticulum formation also involves the terminal ureter and is responsible for impairment of the intrinsic uretero‐vesical valve mechanism. 5. Orthodox techniques were used to repair the globular narrow neck type of diverticulum, but an overlapping repair was invoked for the wide neck variety.