BLADDER DIVERTICULUM HARBORING AN ARTERIOVENOUS MALFORMATION PRESENTING AS ACUTE GROSS HEMATURIA
*Dr. Purushothaman K., MBBS, DNB (General Surgery), Dr. Deepak David, MS (General Surgery), M.Ch (Urology), DLS, Dr. Devaprasath Jeyasekharan, MBBS, MS (General Surgery), FAMS (Urology), FRCS (Edin), Dr. Jeffrey, MBBS, M.Ch (Urology)
Arteriovenous malformations (AVMs) of the urinary bladder are rare vascular anomalies and represent an uncommon cause of gross hematuria. Their occurrence within a bladder diverticulum is extremely rare and can pose a diagnostic challenge during routine evaluation. A 60-year-old male presented with acute painless gross hematuria with passage of clots. Initial cystoscopy was inconclusive due to poor visualization caused by clot retention. Following clot evacuation, repeat cystoscopy revealed a wide-mouthed diverticulum on the left posterolateral bladder wall. Inspection of the diverticulum revealed tortuous pulsatile vessels with active bleeding, consistent with an AVM. The lesion was successfully treated using Holmium:YAG laser fulguration. Bladder AVMs should be considered in cases of unexplained hematuria. Careful cystoscopic evaluation, including inspection of diverticula, is essential. Endoscopic laser fulguration is an effective and minimally invasive treatment option.
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