A bladder diverticulum is an outpouching of the bladder wall that is either congenital or acquired. Bladder diverticula can be clinically silent or cause symptoms related to obstruction, urinary stasis, and other mechanisms as well. In many cases, it is diagnosed accidentally.
A bladder diverticulum is defined as the herniation of mucosal tissue through the bladder wall, hence creating an outpouching of the wall. Bladder diverticula are either congenital (primary) or acquired (secondary)  and the size and number are variable. The former type includes primary congenital bladder diverticulum (PCBD) and congenital syndromes such as Ehlers-Danlos syndrome, Prune-belly syndrome, Diamond-Blackfan syndrome, and others as well. The bladder outpouching in PCBD is not related to obstruction but is a consequence of an inadequate bladder wall due to a deficiency in the detrusor layer . Investigators in one study managing predominantly male children with PCBD revealed that common manifestations included urinary tract infection with fever and hydronephrosis .
The acquired form is more common and develops in response to high pressure on the trabeculated bladder wall, which is typically secondary to bladder outlet obstruction in the setting of benign prostatic hypertrophy (BPH) . Although BPH accounts for most cases of bladder diverticula , other causes include urethral stricture, bladder neck stenosis, neurogenic bladder, posterior urethral valves, and ureterocele. Diverticula may also result as a postoperative complication.
Regarding the clinical presentation, a majority of diverticula do not produce symptoms and are found incidentally through evaluation for hematuria, urinary tract infection, or bladder outlet obstruction . Men with obstruction secondary to BPH will report trouble with urination and incomplete voiding .
Due longstanding urinary stasis, patients with bladder diverticula are at risk for developing bladder stones and infection . Other serious complications include bladder rupture  and intra-diverticular transitional cell carcinoma .
Entire Body System
Recurrent Urinary Tract Infection
The major clinical conditions are recurrent urinary tract infection (UTI) and voiding dysfunction. This report describes a 15-year-old male adolescent who developed sudden visual disturbance resulting from hypertensive retinopathy. [ncbi.nlm.nih.gov]
mass. ( 28325718 ) Nabavizadeh R....Nabavizadeh A. 2017 9 Iatrogenic Bladder Diverticulum 11 Years After Sacrospinous Ligament Fixation for Apical Prolapse. ( 27782977 ) Gephart L.F....Larsen W. 2017 10 Vesico-umbilical fistula in a child with severe [malacards.org]
This report describes a 15-year-old male adolescent who developed sudden visual disturbance resulting from hypertensive retinopathy. The cause of hypertension was bilateral obstructive uropathy caused by enlarged paraureteral bladder diverticula. [ncbi.nlm.nih.gov]
Retinopathy. ( 29441752 ) Kim S....Han H.S. 2018 5 Labial swelling; anterior perineal herniation of urinary bladder diverticulum. ( 29604286 ) Khan I....Shah O.A. 2018 6 Congenital Bladder Diverticulum in Adults: A Case Report and Review of the Literature [malacards.org]
Urinary bladder diverticulum should neither be neglected nor ignored. Appropriate early treatment (including the cause) of the diverticulum should be undertaken to avoid complications like malignancy which will finally ensure longevity. [ncbi.nlm.nih.gov]
Urinary fistulaeCongenital urinary fistula Ectopia vesicae; in association with imperforate anusTraumatic urinary fistulaVesicovaginal fistulaEtiology Obstetrics — the usual cause is protracted or neglected labour; Gynaecological — the operations chiefly [slideshare.net]
We present the case of a 73-year-old man affected by progressive and painful abdominal distension and paresthesia/hypoesthesia at the left leg. [ncbi.nlm.nih.gov]
A 47-year-old man presented with hematuria and dysuria. He was found to have a carcinosarcoma originating from a bladder diverticulum. He underwent a partial cystectomy and received postoperative chemotherapy. [ncbi.nlm.nih.gov]
Regarding the clinical presentation, a majority of diverticula do not produce symptoms and are found incidentally through evaluation for hematuria, urinary tract infection, or bladder outlet obstruction. [symptoma.com]
It may cause VUR, recurrent urinary tract infection, stone formation and urinary incontinence. [indianjurol.com]
Tension-free vaginal tape for the treatment of stress urinary incontinence. Clin Obstet Gynecol 2000; 43: 670-675. 24） Mansoor A, Védrine N, Darcq C. [minds.jcqhc.or.jp]
Particular attention is paid to the treatment of patients with tumors of the urinary tract, kidneys, urolithiasis, prostate diseases, treatment of urinary incontinence/neurourology, andrology and pediatric urology. [bookinghealth.com]
Urinary Incontinence: Urinary incontinence (the involuntary loss of urine) is rare after this surgery. If present before the operation, it is usually due to a pre-existing condition other than the diverticulum. [deltamedix.com]
Urethral diverticulum may cause a myriad of symptoms, such as: dysuria nocturia flank pain hematuria pelvic pain dyspareunia incontinence urinary retention recurrent cystitis frequent, urgent urination frequent urinary tract infections Many diverticulum [healthblurbs.com]
Medlars ProCite RefWorks Reference Manager 2019 Oxford University Press Close Navbar Search Filter Mobile Microsite Search Term Close search filter search input A previously healthy 73-year-old man visited our clinic for 2 weeks history of dysuria and nocturia [qjmed.oxfordjournals.org]
His symptoms of difficulty of urination, increased urinary frequency, nocturia and urgency became worse when the groin swelling increased in size. The patient used to reduce the swelling manually to improve the symptoms. [wjes.biomedcentral.com]
While many bladder diverticula are typically discovered incidentally during a workup for urinary features , symptomatic cases associated with congenital syndromes, BPH, or other causes should raise the clinician's suspicion for this bladder defect. The diagnosis is confirmed through imaging studies as well as the patient's history and physical exam.
Very importantly, investigations such as the voiding cystourethrography (VCUG), ultrasonography (abdominal and bladder), and a nuclear renal scan will collectively guide the urologic team with preoperative and postoperative assessment . Specifically, VCUG is the superior imaging technique for the diagnosis of bladder diverticula . This test produces optimal results when lateral and obliques views are obtained and fluoroscopy is used throughout the procedure .
Bladder ultrasonography with color doppler enhancement is another beneficial modality since it helps detect the defect, differentiates it from other lesions, and identifies dilated distal ureters . Furthermore, an intravenous pyelography (IVP) is particularly useful in diagnosing lateral bladder diverticula. Finally, the upper urinary tract should be imaged since bladder diverticula can lead to hydroureteronephrosis .
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