Congenital urinary bladder anomalies often occur without other GU abnormalities. They may cause infection, retention, incontinence, and reflux. Symptomatic anomalies may require surgery.

Bladder diverticula

Bladder diverticula predispose to UTIs and may coexist with vesicoureteral reflux. They are usually discovered during evaluation of recurrent UTIs in young children. Diagnosis is by voiding cystourethrography. Surgical removal of diverticula and reconstruction of the bladder wall may be needed.

Exstrophy

The bladder is open suprapubically, and urine drips from the opening rather than through the urethra. The bladder mucosa is continuous with the abdominal skin, and the pubic bones are separated. Despite the seriousness of the deformity, normal renal function usually is maintained. The bladder can usually be reconstructed and returned to the pelvis, although vesicoureteral reflux invariably occurs and is managed as needed. Continent urinary diversion may be used to treat a bladder reservoir that fails to expand sufficiently or has sphincter insufficiency. Reconstruction of the genitals is required.

Megacystis syndrome

In this syndrome, a large, thin-walled, smooth bladder without evident outlet obstruction develops, usually in girls. Megacystis syndrome is poorly understood. The syndrome may be a manifestation of a primary myoneural defect, especially when intestinal obstruction (megacystis-microcolon, intestinal hypoperistalsis syndrome) is also present. Symptoms are related to UTIs, and vesicoureteral reflux is common. Ultrasonography with the bladder empty may disclose normal-appearing upper tracts, but voiding cystourethrography may show reflux with massive upper tract dilation. Ureteral reimplantation may be effective, although some patients benefit from antibacterial prophylaxis, timed voiding with behavioral modification, intermittent catheterization, or a combination.

Last full review/revision January 2010 by Ronald Rabinowitz, MD