Bladder Evaginations (Differential Diagnosis Hematuria)

hage_12a_n.jpg: Drawing of an evagination of the bladder near the orifice of the ipsilateral ureter. hage_12b_n.jpg: Endoscopic picture of a bladder evagination !£hage_12b_p£! similar to hage_12a_n.jpg. At the lower border of the evagination a reddish zone with a central elongated structure at 7 o'clock is visible. hage_12c_n.jpg: Endoscopic picture of another bladder evagination; in the depth of the evagination an opening is recognizable through which a ureter catheter has been introduced.hage_12a_n.jpg to hage_12c_n.jpg: These evaginations are bladder diverticula of different origin which lie all within the limits of the bladder trigone near a ureter orifice. In hage_12a_n.jpg and hage_12c_n.jpg the corresponding orifice has become involved in the diverticulum due to an increase in the size of the diverticulum; this process called extravesicalization of the orifice leads to an incompetence of the vesicoureteral valve and to a secondary reflux. In hage_12b_n.jpg the orifice lies at the border of the diverticulum !£hage_12b_p£!. In the foreground of the clinical presentation are recurrent urinary tract infections in bladder diverticula with or without vesicoureteral reflux. The diverticula as well as the combined urinary tract infection may be the cause of hematuria. Here, the diverticula are mentioned as representatives for all urological malformations which also may lead to hematuria.