Urinary bladder diverticulum

Last revised by Ammar Ashraf on 8 Nov 2024

A urinary bladder diverticulum (plural: diverticula) is an outpouching from the bladder wall, whereby mucosa herniates through the bladder wall. It may be solitary or multiple in nature and can vary considerably in size.

There are two peaks; one at 10 years and the other at 60-70 years 2.

Diverticula may be congenital (primary) or acquired (secondary) and a range of causes of urinary bladder diverticula are described.

Acquired diverticula are more common, usually occurring in the context of a trabeculated bladder, resulting from chronic bladder outlet obstruction.

While normal intravesical pressure is approximately 30cm of water at the commencement of micturition, 2-4 times this pressure may be achieved by a hypertrophied (trabeculated) bladder in an attempt to overcome outlet obstruction 9. This increase in pressure forces mucosa between superficial muscle bundles causing small pockets or cellules to form 9.

If these cellules are forced entirely through the muscular layer of the bladder they form saccules and then finally diverticula. It is important to note these diverticula contain no muscular wall and therefore cannot effectively expel their contents regardless of whether obstruction is relieved 9.

Diverticula are often an incidental finding on imaging investigations, including ultrasound, CT, MRI and IVU.

They may be associated with a range of complications due to stasis and low-grade infection including:

Cases and figures

  • Case 1: on IVU
  • Case 2: on CT
  • Case 3: on ultrasound
  • Case 4: from prostatomegaly
  • Case 5
  • Case 6: severe
  • Case 7: transitional cell cancer in a diverticulum
  • Case 8
  • Case 9: due to posterior urethral valve
  • Case 10
  • Case 11
  • Case 12
  • Case 13: TCC in diverticulum
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