- Persistent urachus (Poster of Urachus)
- Contracture of the bladder neck
- Congenital Diverticula
- 1. Interstitial cystitis (or submucosal fibrosis or Hunner’s Ulcer)
- 2. Urinary Incontinence / Enuresis
- 3. Vesical manifestations of allergy
- 4. Internal Vesical Herniation
- 5. Diverticula(e)
- 6. Perivesical Lipomatosis
- 7. Vesical fistulas
They are not so common and are of different origin in the different continents: in Africa they are usually post-partum while in Europe and N. America cancer related.
The vesical fistulas are communications of the bladder with the skin, intestinal tract, or female reproductive organs.
The treatment is always a laborious operations which involves wide excision of the fistula, the inflammatory tissues around it and the parts of the involved organs. Then an “isolation” of the reconstructed organs might be attempted by interposition of omentum.
- 8. Radiation cystitis
Many patients receiving radiation (prostate, cervix) develop a degree of vesical irritability. These symptoms may develop months or years after cessation of treatment. The urine may or may not be sterile. Vesical capacity is usually appreciably reduced. Cystoscopy reveals a pale mucous membrane with multiple areas of telangiectatic blood vessels. If symptoms are severe and prolonged, more invasive treatment could be an option.
- 9. Non-infectious hemorrhagic cystitis
- 10. Empyema of the bladder
- Acute Cystitis
Acute uncomplicated bacterial cystitis affects predominantly women. These are infections that occur in the absence of any anatomic or functional abnormality of the urinary tract. The ascending fecal - perineal – urethral route is the primary mode of infection. men are usually protected by the antibacterial properties of the prostatic secretions.
Nearly 80% of these infections in women are caused by E. Coli bacteria. Also, staphylococcus saprophyticus, enterococci, Klebsiella and Proetus spp, are occasionally diagnosed
The hallmark symptoms are: frequency, urgency, dysuria, sometimes hematuria or cloudy urine with a “strange” not pleasant smell. Low back and suprapubic pain are also frequent complaints. In adults fever and other constitutional symptoms are really rare. Physical examination reveals usually suprapubic tenderness.
- Recurrent / Persistent Urinary Tract Infection (UTI)
Either bacterial persistence or bacterial reinfection leads to recurrent UTIs. The recognition of this natural history of infections in any given patient is important in deciding on therapy. In any case the urologist has to perform imaging assessment and cystoscopy in order to exclude anatomical abnormalities, fistulas, predisposing conditions. Treatment and prophylaxis will be planned according to the findings.
- Amicrobic (abacterial) Cystitis
- Schistosomiasis (Bilharziasis)
- Echonococcosis (hydatid disease)
- Bacteriuria in Pregnancy
During pregnancy, the urinary tract undergoes a number of anatomic and physiologic changes that are caused both by the gravid uterus and by an altered, progestational hormonal milieu. Ureteral peristalsis is generally dampened during pregnancy, and to some degree most women exhibit ureteral dilatation, especially of the right side, by late in the gestation. So, we have a “hydroureter” formed due to progesterone’s effect on smooth muscle and compression. Renal function is also affected. The renal plasma flow and the glomerular filtration rate increases significantly during pregnancy, the later by 30-50%. As a result, average values for serum creatinine and urea nitrogen are lower in pregnant women than in their non-pregnant counterparts. The renal excretion of protein is also increased.
Pregnant women are more susceptible to pyelonephritis than their non-pregnant counterparts, even though the incidence of bacteriuria is not statistically different between these groups. It has been found that treatment of bacteriuria in pregnant women reduces significantly the risk of pyelonephritis. Untreated pylonephritis could lead to a high rate of premature delivery and infant mortality. The effect of the treatment of pyelonephritis to the fetus is controversial but although this remains unclear we do know that bacteriuria in pregnant women should be treated regardless of symptoms.
This could be managed conservatively (introduction of per urethra catheter) if we have a limited extraperitoneal rupture or with an open or laparoscopic procedure (robotically assisted) if the rupture is intraperitoneal.
Bladder Tumors / Cancer