beidseitiges periureterales Divertikel der Harnblase (Hutch-Divertikel)

Hutch
diverticulum - A rare presentation in an adult. The bladder USG shows bilateral fluid-filled outpouchings at the bladder base at the vesico-ureteric junctions.
www.eurorad.org • CC by-nc-sa-4.0
Hutch
diverticulum - A rare presentation in an adult. Well-defined bilateral outpouchings showing fluid density within, noted at the bladder base at the vesico-uretric junctions.
www.eurorad.org • CC by-nc-sa-4.0
Lizenz: CC BY-SA 4.0

beidseitiges periureterales Divertikel der Harnblase (Hutch-Divertikel)

hutch diverticulum Radiopaedia • CC-by-nc-sa 3.0 • de

Hutch diverticula are congenital bladder diverticula, seen at the vesicoureteric junction, in the absence of posterior urethral valves or neurogenic bladder. They are thought to result from a weakness in the detrusor muscle anterolateral to the ureteral orifice.

Epidemiology

They occur almost exclusively in boys with an estimated prevalence of approximately 2% .

Clinical presentation

Urinary tract infection, incontinence, or urinary retention are the most common presentations.

Pathology

Hutch diverticula are commonly seen with vesicoureteric reflux, because the normal oblique insertion of the ureter is disrupted.

Associations

Radiographic features

Fluoroscopy

On voiding cystourethrogram, contrast-filled outpouchings from the urinary bladder arise at the vesicoureteric junction, giving "Mickey Mouse appearance" . Vesicoureteral reflux is often associated.

Ultrasound

Round or oval anechoic fluid collections arising from the base of the urinary bladder or around the ureteric orifice .

Treatment and prognosis

Incidentally detected diverticula usually do not require any therapy. If associated with reflux, recurrent infection, or obstruction, they should be resected. However, because of the risk of the development of carcinoma, some surgeons advocate prophylactic surgery in all cases. Hutch diverticula are prone to spontaneous rupture, as well as post-surgical recurrence.

History and etymology

Primary and secondary paraureteric diverticula were first described by American urologist John Hutch (-1972) in 1961 .

Differential diagnosis

  • "bladder ears"
    • these are transient outpouching normally seen in infants, and represent normal protrusions of urinary bladder into the inguinal rings
    • lateral voiding cystourethrogram usually clarifies the diagnosis

See also

Siehe auch:
Assoziationen und Differentialdiagnosen zu beidseitiges periureterales Divertikel der Harnblase (Hutch-Divertikel):