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February 11, 1939


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JAMA. 1939;112(6):509-513. doi:10.1001/jama.1939.02800060025005

The importance of vesical diverticulum is emphasized by the fact that badly infected, poorly draining diverticula, with the resulting stagnation and eventual ammoniacal urine, give rise to subjective symptoms not exceeded in severity by those of advanced vesical tuberculosis, carcinoma or calculus.

Vesical diverticulum is a form of herniation through points of weakness between muscular fibers interlacing at approximately a right angle. These so-called weakened spots may be due to embryologic defects or, presumably, may result from pathologic changes in the bladder wall produced by infection, inflammatory changes and back pressure. In practically every case there is evidence of increased intravesical pressure over a long period, almost always caused by obstruction at the bladder outlet. With few exceptions prostatism. in one form or another, is present and accounts for the back pressure, without which there would be no diverticulum. The dictum that two factors, weak spots and obstruction, are necessary

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