Bladder Diverticulum

Many people may have small, bulging pouches in their bladder and never know it. These
pouches are usually harmless but read on to learn more about what problems they can cause.

What is a bladder diverticulum?

Bladder diverticula are pouches in the bladder wall that a person may be either born with
(congenital) or later acquire. A congenital bladder diverticulum represents an area of weakness in
the bladder wall through which some of the lining of the bladder is allowed to protrude.
Congenital diverticula are generally solitary and are most often discovered during childhood.
They often require no specific treatment. Acquired bladder diverticula are typically the result of
obstruction of the bladder outlet (e.g. an enlarged prostate or area of scarred urethra), bladder
dysfunction from nerve injury or, rarely, as a result of prior bladder surgery. Acquired diverticula
are often multiple and typically seen in older men (mirroring the incidence of obstruction of the
bladder outlet).

What are the symptoms of a bladder diverticulum?

Bladder diverticula often do not produce specific symptoms but may be associated with urinary
tract infections, difficulty voiding or abdominal fullness, particularly if they become large
causing the bladder to empty incompletely. Most commonly, bladder diverticula have no direct
symptoms but are incidentally discovered while looking for causes of other urinary difficulties
such as urinary tract infections, trouble urinating or blood in the urine.

How is a bladder diverticulum diagnosed?

Bladder diverticula may be suspected when a patient has symptoms such as recurrent infection,
difficulty voiding or abdominal fullness that suggest blockage of the bladder outlet and urinary
stasis. However, patients may have no specific symptoms and diverticula can be found while
performing tests for other problems. An X-ray test (cystogram) of the bladder performed by
filling the bladder with contrast dye and taking pictures is an excellent means of detecting
bladder diverticula. Diverticula may also be found by passing a scope into the bladder through
the urethra (cystoscopy), which is important for checking that no bladder tumors are found in the
diverticulum. The function of the bladder and the presence of obstruction of the bladder outlet
may be assessed with a bladder pressure test (urodynamics). Finally, it may be necessary, in
some cases, to check the effect of obstruction on the kidneys if obstruction is suspected using
ultrasound of the kidneys.

How is a bladder diverticulum treated?

Congenital or acquired diverticula do not always require treatment, particularly if they are not
associated with urinary infections, bladder stones, backwards flow of urine into the kidneys
(reflux), bladder tumors or difficulty urinating. For those patients with diverticula acquired as a
result of bladder obstruction, treatment should include relief of the obstruction and may or may
not include removal of the diverticulum. Removal of the diverticulum is via an open surgery with
removal from inside the bladder, though surgery outside of the bladder may be necessary as well.
This surgery may be somewhat difficult because of the inflammation of a chronically infected
diverticulum. In some patients who cannot undergo an open surgery, the diverticulum can be
treated by enlarging its opening into the bladder.
What can be expected after treatment for bladder diverticulum?
Treatment will usually have good results and may result in complete resolution of symptoms. In
some patients, removal of the underlying cause, such as obstruction of the bladder, may result in
no further symptoms and does not require further therapy. In these cases, periodic checks of the
diverticulum with a scope in the bladder through the urethra (cystoscopy) may be indicated.
Some patients will require removal of the diverticulum via an open surgery either at the time of
treatment of the bladder obstruction or subsequently. Occasionally, patients who have poorly
functioning bladders will need to assist bladder emptying with a catheter even after treatment.
For patients undergoing surgical treatment, catheter drainage of the bladder is indicated for one
to two weeks. Rarely, surgical therapy for a bladder diverticulum is associated with injury to the
intestines, injury to the urine tubes from the kidneys (ureters), an abnormal connection of the
bladder to the intestines (fistula), prolonged urine leakage from the bladder after surgery or
infections.

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Bladder Diverticulum

A bladder diverticulum is an outpouching in the bladder and is often asymptomatic.

Occasionally, they can cause problems like recurrent urinary tract infections or bladder cancer.

What is a bladder diverticulum?

A diverticulum is an outpouching in the bladder. It can be either congenital (born with) or
acquired. Congenital diverticula are usually diagnosed in childhood or on prenatal ultrasound.
Acquired bladder diverticula are often due to bladder outlet obstruction from an enlarged
prostate, urethral stricture (scar tissue in the tube which we urinate out), or neurologic disease.
Acquired diverticula are most ypically seen in elderly men and often associated with benign
prostatic hyperplasia (BPH).

What are the symptoms of a bladder diverticulum?

Bladder diverticula are often asymptomatic but can also be symptomatic. Some of the symptoms
including urinary retention (inability to urinate), urinary tract infection, or blood in the urine.
They are often found incidentally on imaging for other conditions.

How is a bladder diverticulum diagnosed?

Bladder diverticula are often diagnosed on imaging studies like a CT scan or ultrasound
incidentally. . After the initial suspicion, more specific tests like a cystogram (X-ray tests of the
bladder filled with contrast dye) or cystoscopy (placing a scope into the bladder via the urethra)
can confirm the diagnosis.
How is a bladder diverticulum treated?
Congenital or acquired diverticula do not always require treatment, particularly if they are not
associated with urinary infections, bladder stones, or urinary reflux. (backwards flow of urine
into the kidneys) Bladder diverticula associated with bladder tumors, recurrent infection, or
urinary retention do need treatment. For patients with diverticula and urinary obstruction,
treatment will include relief of the obstruction and possible removal of the diverticulum Bladder
diverticulum can be treated with both open and laparoscopic (using small incision and camera
holes) to perform the surgery.

What can be expected after treatment for bladder

diverticulum?
The treatments offered have excellent results and can result in complete resolution of urinary
symptoms. Most men will usually void much better after surgery. There is some followup after
surgery to ensure that the bladder is emptying well. For individuals undergoing open surgery, a
catheter is usually required for 1 to 2 weeks. For individuals with poorly functioining bladder
due to long term obstruction, patients may need to undergo intermittent catherization to empty
the bladder. Other risks including injury to the intestines or rectum is extremely rare.

UrologyHealth.org Glossary
intestines: the portion of the alimentary canal extending from the stomach to the anus consisting
of two segments, the small intestine and the large intestine.

, injury to the urine tubes from the kidneys (ureters), an abnormal connection of the bladder to
the intestines (fistula), prolonged urine leakage from the bladder after surgery or infections.

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