Presentation
Long standing difficulties in passing urine. History of TURP.
Patient Data
Grossly thick-walled bladder with multiple diverticula. Note marked increase in vascularity to the bladder wall, especially at the dome. The patient has an inflatable penile erection device with the fluid reservoir in the left groin adjacent to the bladder.
Delayed post contrast imaging
Diverticula all fill with contrast excreted from the kidneys. Note the central prostatic cavity following previous trans-urethral resection.
Case Discussion
Bladder diverticula or pseudodiverticula (since their walls are not full-thickness) occur as a result of prolonged raised intracystic pressure generated with detrusor muscle contraction against an obstructed bladder outlet at the prostatic urethra. This is an extreme case.