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Welcome to the Why Urology podcast with Dr. Todd Brandt.

This podcast is my personal attempt to teach you about your genito-urinary tract, what can go wrong, and how your urologist may just become your superhero.

The name of the podcast comes from my ongoing need to answer the question that I get so often from patients, friends, and family, “Why Urology? Why did you choose to become a urologist?”

May 20, 2018

Medical illustration has always been important in Urology.   The Urological history museum is named after a foremost illustrator in the field of urology, William P. Didusch.

In my office, I have also drawn many pictures over the years to help illustrate for patients what their urological problem is.  Pictures that I have drawn over and over again have become permanently laminated and I pull them out as I am speaking with patients rather than search for a blank piece of paper and poorly reproduce the drawing.

As I look for solace about my drawing ability I find it in the words of two illustrators, Walt Disney (yes, that Walt Disney…maybe you have heard of him?) and aforementioned Max Brodel, considered to be the father of medical illustration.

A bladder diverticulum is an outpouching/herniation through the bladder wall through a weak part in the bladder wall. 

A bladder diverticulum may either be congenital (something you are born with) or acquired (something you get later in life).  

 A congenital diverticulum is most often found when you are still a child, and there is often only one diverticulum in the bladder. A congenital diverticulum often does not need to be treated.

 Acquired bladder diverticula are most often caused several different factors: 1) by a block in the bladder outlet (such as from a swollen prostate or urethral stricture), 2) a dysfunctional or neurogenic bladder, or, more rarely, 3) from prior bladder surgery. With acquired diverticula, many pockets often form, with one or two growing over time to become larger, sometimes larger than the bladder itself. Bladder diverticula are most often seen in older men as a result of BPH, benign enlargement of the prostate, who tend to get trabeculation of the bladder, cellules and saccules of the bladder and, ultimately, diverticula.  

I use the following mental image a lot. People seem to remember those dolls that look like martians where you squeeze the body and their eyes and ears pop out. The toy is called Bug Out Bob squeeze toy or Panic Pete online today and you can still purchase one to relieve your stress if you want.

Most often, bladder diverticula have no direct signs or symptoms. They are most found while looking for causes of other urinary problems: urinary tract infections, blood in the urine, bladder stones, urine flowing backwards into the kidneys ("reflux"), bladder tumors, difficulty emptying the bladder.

Bladder diverticula can be found with an x-ray test of the bladder and/or a cystoscopy. The xray test is done by filling the bladder with a dye that shows up well in x-rays (called a "contrast") and taking pictures, either with plain xray or with a CT scan. A cystoscope, a long, thin flexible scope with a light at the end is used to check the lining of the diverticulum, primarily to check for bladder tumors in the diverticulum. Other tests may also be performed. A "urodynamics" test may also be done to see how well the bladder works  and ultrasound tests can determine if the bladder is emptying or if the diverticulum is affecting the kidneys.

Bladder diverticula don't always need to be treated if they're not causing any problems. If the diverticulum is causing problems though, surgical removal is usually required. It is also very important to treat the underlying cause of the diverticulum as well. In the case of a man with BPH, treating the underlying prostate enlagement and obstruction prevents further diverticulum from forming.

We usually use the da Vinci robot to perform the surgery for removal of the diverticulum. This surgery may be hard if the diverticulum has been infected and is swollen, but in general the procedure ca be performed in an hour or two with a single night’s stay in the hospital afterward. A patient will have to wear a catheter for five to seven days after the surgery, but can begin urinating normally once the catheter is removed. 

Most surgeries are very successful but some risks of diverticulum surgery are damage to the intestines or ureters, urine leaking from the bladder after surgery, blood in the urine, and bladder infections.

YouTubevideo link: https://www.youtube.com/watch?v=BH8zyzBk3s0

Washington Post Article link: http://www.washingtonpost.com/wp-dyn/articles/A40150-2002Jul8_5.html

Urology Care Foundation link: http://www.urologyhealth.org/urologic-conditions/bladder-diverticulum