periureterales Divertikel der Harnblase (Hutch-Divertikel)

Urinary
bladder diverticula (causes) • Hutch diverticulum - Ganzer Fall bei Radiopaedia
Jha, P. Hutch diverticulum. Case study, Radiopaedia.org. (accessed on 03 Nov 2022) https://doi.org/10.53347/rID-16179 • CC by-nc-sa 3.0 (modified)
Hutch
diverticulum - A rare presentation in an adult. Note the fluid-filled outpouching at the right vesico-ureteric junction. The lower end of the right ureter is dilated and is seen to drain into the outpouching.
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Hutch
diverticulum - A rare presentation in an adult. Hydronephrosis and hydroureter up to the lower end on the right side. The lower end of the ureter is seen to open into the outpouching.
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Hutch
diverticulum - A rare presentation in an adult. Scarred left kidney. The left ureter is seen to drain into the outpouching. Bladder wall thickening is also noted.
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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:
und weiter:
Assoziationen und Differentialdiagnosen zu periureterales Divertikel der Harnblase (Hutch-Divertikel):
beidseitiges
periureterales Divertikel der Harnblase (Hutch-Divertikel)
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