title: Bladder pseudodiverticulum and debilitating dyspareunia: diagnostic and management dilemmas of a rare case.
abstract: Dyspareunia in a woman often lacks a well-defined cause with complex etiology. Similarly wide-mouthed nonobstructive bladder diverticula are mostly managed conservatively with no single etiology. Herein a rare case of dyspareunia and urinary symptoms is described, which started following a lower segment cesarean section (LSCS). Ultrasonography, micturating cystogram, and cystoscopy revealed a large wide-mouthed bladder diverticulum. After 3 years of failed and varied conservative therapy and management dilemmas, exploration was done for diverticulectomy which revealed a diagnostic surprise. A post-LSCS thick adhesive band was found between the uterus and anterior abdominal wall as a direct cause for both the bladder diverticulum and dyspareunia. Adhesions after LSCS may cause varied symptoms which may be difficult to diagnose and leave the patient refractory to conservative therapy. Laparoscopy or exploration may be useful in such cases.
authors.affiliation: Department of Urology, PGIMER and Dr RML Hospital, Baba Kharak Singh Marg, New Delhi, 110001, India, nayyarrishi@gmail.com.
authors.forename: Rishi
authors.initials: R
authors.lastname: Nayyar
authors.forename: Rajeev
authors.initials: R
authors.lastname: Sood
authors.forename: Bharti Uppal
authors.initials: BU
authors.lastname: Nayyar
authors.forename: Nikhil
authors.initials: N
authors.lastname: Khattar
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects*; D003951:Diagnostic Errors; D004240:Diverticulum / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D004414:Dyspareunia / Q000209:etiology*; D005260:Female; D006801:Humans; D059411:Lower Urinary Tract Symptoms / Q000188:drug therapy / Q000209:etiology; D000267:Tissue Adhesions / Q000175:diagnosis / Q000209:etiology; D001745:Urinary Bladder Diseases / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy