Divertículo vesical congénito: causa de obstrucción al tracto urinario

ResumenSe presenta el caso clínico de un paciente masculino de 2 meses de edad quien ingresa a servicio de Cirugía Pediátrica del Hospital G. Parres por cuadro de urosepsis por enterococus. Con antecedente de cursar con hidronefrosis bilateral y vejiga distendida visto por ecografía. Se realiza derivación urinaria con sonda, y se envía a nuestra institución por uropatía obstructiva.Se realizan estudios de imagen para abordaje diagnóstico. El 29.09.09 se realiza cistograma miccional donde se observa vejiga septada que comunica directamente con la uretra y reflujo vesicoureteral derecho grado iii (GIII). Se solicita uro-TAC en la cual se observa divertículo vesical paraureteral derecho y reflujo vesicoureteral GII.Se decide realizar uretrocistoscopia donde se observa divertículo vesical en pared derecha muy grande, no se observa meato ureteral izquierdo. El 14.12.09 se realiza gammagrama renal que evidencia pieloectasia bilateral, ureterocele derecho, reflujo vesicoureteral bilateral GIII. Función de riñón derecho, 46.1 (41%) y función de riñón izquierdo, 66.2 (59%).El 15.02.10 se realiza resección de divertículo y reimplante ureteral derecho tipo Politano Leadbetter con reparación de piso vesical. El 04.05.10 en el cistograma miccional se observa vejiga de bordes irregulares con capacidad de 50 cc, cuello con adecuada apertura, sin reflujo y uretra permeable en todo su trayecto. A los 11 meses, paciente asintomático ya sin profilaxis.

The clinical case of a 2-month-old male infant is described herein. The patient was admitted to the Pediatric Surgery Service of the Hospital G. Parres with symptoms of urosepsis due to Enterococcus. His past history included bilateral hydronephrosis and an ultrasound study revealed a distended bladder. A urinary diversion with catheter was performed and the patient was referred to our institution due to obstructive uropathy.Imaging studies were carried out for the diagnostic approach. A voiding cystogram was performed on 29.9.09 that showed a septate bladder communicating directly with the urethra and grade III vesicoureteral reflux. Computed tomography urography was ordered and revealed a right paraureteral bladder diverticulum and grade II vesicoureteral reflux.Urethrocystoscopy was performed and showed a very large bladder diverticulum at the right wall; the left ureteral meatus was not observed. A kidney scintigram done on 14.12.09 identified bilateral renal pelvis dilation, right ureterocele, and grade III bilateral vesicoureteral reflux. Kidney function was within normal limits: right kidney 46.1 (41%) and left kidney 66.2 (59%).The diverticulum was resected and a right Politano-Leadbetter ureteral reimplantation with bladder floor repair was performed on 15.02.10. A voiding cystogram carried out on 04.05.10 showed a bladder with irregular borders and a capacity of 50 cc, a neck with adequate opening, no reflux, and a permeable urethral tract. At 11 months the patient was asymptomatic and no longer undergoing antibiotic prophylaxis.