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) [1] 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 [2]. Investigators in one study managing predominantly male children with PCBD revealed that common manifestations included urinary tract infection with fever and hydronephrosis [3].

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) [4]. Although BPH accounts for most cases of bladder diverticula [4], 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 [1]. Men with obstruction secondary to BPH will report trouble with urination and incomplete voiding [4].

Complications

Due longstanding urinary stasis, patients with bladder diverticula are at risk for developing bladder stones and infection [1]. Other serious complications include bladder rupture [5] and intra-diverticular transitional cell carcinoma [6].

• Pain

  The minimally invasive approach allowed for easy identification and dissection of the diverticulum and surrounding vital structures with minimal postoperative pain and a good cosmetic result. [ncbi.nlm.nih.gov]

  During these episodes she has fever, nausea, dysuria (painful urination) and left flank pain. Her renal and bladder ultrasound shows two normal kidneys. You order this voiding cystourethrogram. [meddean.luc.edu]

  They are solitary and present with infection, haematuria and abdominal pain. They are associated with a smooth walled bladder without bladder outlet obstruction. An adult male presented with voiding symptoms and lower abdominal pain. [academic.oup.com]

• Recurrent Urinary Tract Infection

  Since then he had been suffering from recurrent urinary tract infections and urinary leak, which used to be treated symptomatically. [ncbi.nlm.nih.gov]

• Fever

  Bladder diverticulum should be a differential diagnosis in children, especially male, presenting with urinary retention, fever and an abdominal mass. [ncbi.nlm.nih.gov]

  A 73-year-old man presented to the emergency department after having intermittent fevers for 2 weeks. [nejm.org]

• Chills

  This type of infection can present with both urinary symptoms and any combination of the following: fevers, shaking chills, weakness or dizziness, nausea and vomiting. [deltamedix.com]

  Fevers greater than 101º F, excessive chills. Nausea and vomiting or inability to keep down fluids. If you have any questions or concerns that are not covered by this handout. [flinturology.com]

• Malaise

  When infection is present there may be fever and malaise. Attacks of diverticulitis may last only a few days but are more likely to go on over one or two weeks or longer. [indianjmedsci.org]

• Aspiration

  During this admission, transvaginal ultrasound-guided cyst aspiration was arranged to determine the nature of the presumed 'recurrent' cyst and to relieve the symptoms. [ncbi.nlm.nih.gov]

  Urologist called and first he aspirated fluid and it was urine. Then while separating the swelling from uterus bladder opened and resected the diverticulum. Bladder was sutured. Abdomen was closed. [scopemed.org]

  We leave an aspirating drain in the Retzius space and a urethral 18-Fr Foley catheter, which may both be removed after 5 or 6 days. [urologysurgery.wordpress.com]

  Additionally, mentioned were the possible serious complications of the anesthesia to include cracked teeth, airway damage, aspiration, pneumonia, spinal headache, nerve damage, spinal canal bleeding and malignant hyperthermia. [flinturology.com]

• Flatulence

  There may be either constipation or diarrhea, and flatulence or an excess of wind is common. When infection is present there may be fever and malaise. [indianjmedsci.org]

• Fear

  The transurethral approach for the treatment of diverticular tumors is often difficult and inappropriate due to the narrow diverticular neck, thin submucosal layers, and fear of bladder perforation with complete resection. [urotoday.com]

  I know too well the fears that having cancer brings. Thanks again! My husband had the same thing removed surgically in 1992 with no other treatment. Cancer did not rear its ugly head for ten years after that. Then BCG and Turbts until 2013. [inspire.com]

• Urinary Retention

  Urinary tract infection and urinary retention are the most frequent presentation forms. In this case CBD produce urinary obstruction as a result of compression of the urethra which causes urinary retention. [ncbi.nlm.nih.gov]

• Hematuria

  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]

• Dysuria

  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]

  During these episodes she has fever, nausea, dysuria (painful urination) and left flank pain. Her renal and bladder ultrasound shows two normal kidneys. You order this voiding cystourethrogram. [meddean.luc.edu]

• Incontinence

  […] cancer gallbladder disease genitourinary neoplasm glomerular disease glomerulonephritis gout hepatic encephalopathy hepatorenal syndrome hydronephrosis hypospadias incontinence interstitial cystitis interstitial nephritis kidney cancer kidney disease [med.nyu.edu]

  Manifestations include recurrent UTIs and urinary retention and/or incontinence. The underlying neurologic abnormality is usually readily apparent. [merckmanuals.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]

  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]

  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]

• Urinary Incontinence

  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]

  It may cause VUR, recurrent urinary tract infection, stone formation and urinary incontinence. [indianjurol.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]

  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]

While many bladder diverticula are typically discovered incidentally during a workup for urinary features [7], 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.

Imaging

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 [8]. Specifically, VCUG is the superior imaging technique for the diagnosis of bladder diverticula [9]. This test produces optimal results when lateral and obliques views are obtained and fluoroscopy is used throughout the procedure [10].

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 [11]. 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 [7].

Two years after initial treatment, the patient was well without evidence of tumor relapse. [ncbi.nlm.nih.gov]

➤Treatment of urinary bladder diverticulum with surgical excision of diverticulum ★ Direct prices from the best hospitals in the world $ We will help you save money on treatment ✔ Patient support 24/7 Treatment prices are regulated by national law of [bookinghealth.com]

Small cell carcinoma of the urinary bladder is a mass with swiftly aggressive and metastatic, and with a poor prognosis. [ncbi.nlm.nih.gov]

This case demonstrates that spontaneous bladder rupture may be a rare cause of abdominal complaints and sepsis when the etiology at first seems unclear. [ncbi.nlm.nih.gov]

In spite of differences in views on UBD etiology, it should be said that up to now division of diverticula into true and false ones is the most common classification. [radiologykey.com]

Pathogenesis Etiology Urachus allows communication between urinary bladder and allantoic sac in fetus. At birth urachus is non-functional and all urine flows through urethra in normal animals. [vetstream.com]

Are examined the epidemiological data (age, gender), the given clinics (functional and physical signs), means of diagnosis and therapeutic results. In this study, only large diverticulums were considered. [afrjpaedsurg.org]

Pytel and Pytel [ 6 ]) False or acquired UBD develop in patients who have had a long-term disturbance of urine discharge from the bladder which appears as urinary difficulty that is most often observed in patients with benign prostate hyperplasia. 3.1 Epidemiology [radiologykey.com]

Epidemiology and risk factors of urothelial bladder cancer. Eur. Urol. 63, 234–241 (2013). 18. Das, S. S. & Amar, A. D. A. Vesical diverticulum associated with bladder carcinoma: therapeutic implications. J. Urol. 136, 1013–1014 (1986). 19. [nature.com]

Pathophysiology Vestigial outpouching of bladder wall at urachal attachment. Diverticulum → failure to void all urine from bladder → development of UTI → scarring of bladder wall → increased risk of UTI. [vetstream.com]

Anatomy, Physiology, and Pathophysiology Bladder diverticulae represent a herniation of the bladder urothelium through the muscularis propria of the bladder wall. [laparoscopy.blogs.com]

It prevents bladder from emptying completely and leads to infection. Treatment - Removing obstruction or surgical removal of the diverticulum. [medindia.net]

This periureteral diverticulum causes vesico-ureteral reflux because it prevents the normal valve mechanism of the distal ureter. [meddean.luc.edu]

Prevention Birth defects often have no precisely identified cause; therefore, prevention is limited to general measures such as early and continuous prenatal care, appropriate nutrition, and a healthy lifestyle. [encyclopedia.com]

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