17,1 Pelzman: Two Urological Cases 87 
provement. The cystitis has practically entirely disappeared; 
the diverticulum, however, is still present. Where previously 
he would void two or three times an hour, he now can go from 
one hour to one and a half hours without voiding; at night 
he gets up to void two or three times instead of ten or twelve 
times. The patient has shown marked improvement, but of 
course will not be permanently cured unless prostatectomy and 
dissection of the diverticular sac be done. To date he has re- 
fused operation. 
Diverticulum of the bladder is more prevalent than was 
formerly supposed, the present more frequent discovery of the 
condition being due to the fact that an absolute diagnosis is 
impossible without the aid of the cystoscope or the X-ray, al- 
though occasionally a fairly accurate diagnosis may be made 
by exclusion. 
The etiology of bladder diverticulum is still sub judice. Some 
contend that this condition is always acquired, basing the con- 
tention principally on the presence or absence of muscular fibers 
in the sac. The probability is that a certain percentage of the 
cases is congenital; or rather, there probably is a congenital 
defect in the bladder wall which, under given conditions, acts 
as a predisposing cause to the development of the diverticulum. 
The majority of urologists believe that diverticula are ac- 
quired. They base this contention on the fact that diverticula 
are scarcely ever found in the very young, but that, for the 
most part, they occur in persons past middle life, at which 
time obstructions to the urinary outlet most frequently occur. 
As yet no experimental data have been offered to prove any 
theory thus far advanced; and, until some unassailable proof 
can be furnished, the exact etiology of diverticula will remain 
unsolved. s 
Symptoms.—Frequent urination with inability to empty the 
bladder completely is one of the commonest signs of the 
presence of a diverticulum. In most cases this does not cause 
any special annoyance until infection and cystitis develop, when 
the patient seeks advice because of the pain accompanying these 
conditions. Octasionally there is a burning or stinging sensa- 
tion during and after micturition. If the diverticulum be in- 
fected, and in most cases it is, the urine even after repeated 
irrigations is cloudy and, in a great many cases, very fetid. 
Diagnosis.—The presence of diverticula can nearly always be 
determined by the cystoscope in the hands of a person ex- 
