Bladder Diverticula

Bladder Diverticula

(Plural of diverticulum)

A bladder diverticulum is a pouch or sac-like outpouching of the bladder wall that protrudes through a weak area in the muscular layer. It may be congenital or acquired, and it can trap urine, leading to complications like infection, stones, or even tumors.

🔍 Types

⚠️ Causes of Acquired Diverticula

• Benign prostatic hyperplasia (BPH)
• Urethral stricture
• Neurogenic bladder
• Chronic bladder overdistension

These conditions cause increased intravesical pressure, forcing the bladder mucosa to herniate through weakened muscular layers.

🩺 Symptoms

May be asymptomatic or present with:

• Recurrent UTIs
• Urinary retention or incomplete emptying
• Double voiding (voiding again shortly after)
• Hematuria
• Bladder stones
• Rarely, diverticular carcinoma

🧪 Diagnosis

1. Ultrasound
   • May show outpouching, especially post-void
2. Voiding cystourethrogram (VCUG)
   • Reveals diverticula during filling and voiding
3. Cystoscopy
   • Direct visualization of the diverticular neck and interior
4. CT Urogram / MRI
   • Helpful in complex cases or to evaluate for malignancy

🛠️ Complications

• Urinary stasis → infections, stones
• Tumors (usually urothelial carcinoma, rare but serious)
• Bladder outlet obstruction
• Vesicoureteral reflux (if diverticulum is near ureteric orifice)

🩹 Treatment

✅ If Asymptomatic:

• Observation, regular monitoring

⚕️ If Symptomatic or Complicated:

1. Treat underlying cause (e.g., relieve BPH or obstruction)
2. Surgical options:
   • Diverticulectomy: removal of diverticulum (open, laparoscopic, or robotic)
   • Endoscopic unroofing: if small and accessible
   • TURP or urethral dilation: for associated outlet obstruction
3. Surveillance:
   • Periodic cystoscopy and imaging if there’s a cancer risk

📈 Prognosis

• Good with treatment
• Requires long-term follow-up if associated with recurrent infections, obstruction, or suspected malignancy