Urinary bladder diverticulum
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View Ammar Ashraf's current disclosures- Bladder diverticulum
- Urinary bladder diverticula
- Urinary bladder diverticulae
- Urinary bladder diverticuli
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.
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Epidemiology
There are two peaks; one at 10 years and the other at 60-70 years 2.
Pathology
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.
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Radiographic features
Diverticula are often an incidental finding on imaging investigations, including ultrasound, CT, MRI and IVU.
Treatment and prognosis
Complications
They may be associated with a range of complications due to stasis and low-grade infection including:
intradiverticular transitional cell carcinoma 1-10% 5-7
References
- 1. Berrocal T, López-Pereira P, Arjonilla A, Gutiérrez J. Anomalies of the Distal Ureter, Bladder, and Urethra in Children: Embryologic, Radiologic, and Pathologic Features. Radiographics. 2002;22(5):1139-64. doi:10.1148/radiographics.22.5.g02se101139 - Pubmed
- 2. Erich Lang. Radiology of the Lower Urinary Tract. (2011) ISBN: 9783642844331 - Google Books
- 3. Shailendra Chopra. Genitourinary Imaging. (2011) ISBN: 9781604063240 - Google Books
- 4. Walker N, Gan C, Olsburgh J, Khan M. Diagnosis and Management of Intradiverticular Bladder Tumours. Nat Rev Urol. 2014;11(7):383-90. doi:10.1038/nrurol.2014.131 - Pubmed
- 5. Melekos M, Asbach H, Barbalias G. Vesical Diverticula: Etiology, Diagnosis, Tumorigenesis, and Treatment. Urology. 1987;30(5):453-7. doi:10.1016/0090-4295(87)90378-5 - Pubmed
- 6. Matta E, Kenney A, Barré G, Vanlangendonck R. Intradiverticular Bladder Carcinoma. Radiographics. 2005;25(5):1397-403. doi:10.1148/rg.255045205 - Pubmed
- 7. Golijanin D, Yossepowitch O, Beck S, Sogani P, Dalbagni G. Carcinoma in a Bladder Diverticulum: Presentation and Treatment Outcome. J Urol. 2003;170(5):1761-4. doi:10.1097/01.ju.0000091800.15071.52 - Pubmed
- 9. Jack W. McAninch, Tom F. Lue. Smith and Tanagho's General Urology, 19th Edition. (2020) ISBN: 9781259834332 - Google Books
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