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.

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What is bladder diverticulum?

They are pouches in the bladder wall that a person is born with (congenital) or later acquires. A congenital bladder diverticulum represents an area of weakness in the bladder wall through which some of the lining of the bladder is forced out. (A small balloon squeezed in a fist will create a diverticular-like effect between the fingers.) Bladder diverticula may be multiple and they often occur at the entrance of the upper urinary system into the bladder (ureterovesical junction). Acquired diverticula are usually related to bladder obstruction, most commonly as a result of benign prostatic hyperplasia (BPH). 

What are the symptoms of bladder diverticulum?

Under normal conditions a diverticulum is of no significance. But sometimes it causes special problems if a bladder tumor happens to be in one, or if one is next to a ureter that allows urine to go from the bladder back up to the kidney (vesicoureteral reflux). Under most situations however, diverticula are without symptoms and not clinically significant. A diverticulum usually becomes significant if it becomes very large and causes incomplete bladder emptying and stagnation of urine. If the urine within the diverticulum becomes infected, that infection may not be able to clear because of the stagnation. Under such circumstances, treatment may be indicated. If a diverticulum is related to bladder outlet obstruction, the obstruction must also be treated.

Diverticulum is not visible and will be detected only if it causes trouble. Usually it is found during an examination for the cause of recurring urinary tract infections. X-rays or a cystoscopy is used to identify it.

Surgical removal is the treatment of a symptomatic bladder diverticulum. This may be done from entirely within the bladder in certain situations, but often requires dissection both inside and outside of the bladder. This surgery may be somewhat difficult because of the inflammation of a chronically infected diverticulum. 

Treatment will usually have good results. Postoperatively, catheter drainage of the bladder is indicated for one to two weeks.  Bladder diverticula are either congenital (you are born with them) or acquired.  Acquired diverticula are usually related to bladder obstruction, most commonly as a result of Benign Prostatic Hypertrophy.  Those that become symptomatic usually are large singular diverticula.

Under normal conditions a diverticulum is of no significance. They sometimes present special problems if a bladder tumor happens to be in one, or if one is next to a ureter that allows vesicoureteral reflux (urine can go from the bladder back up to the kidney). Under most situations however, they are asymptomatic and not clinically significant.  A diverticulum usually becomes significant if it becomes very large and therefore is a cause of incomplete bladder emptying and stagnation of urine. If the urine within the diverticulum becomes infected, that infection may not be able to clear because of the stagnation. Under such circumstances, treatment may be indicated. If a diverticulum is related to bladder outlet obstruction, the obstruction must also be treated. 

Treatment of a symptomatic bladder diverticulum is surgical excision.  This may be done from entirely within the bladder in certain situations, but often requires dissection both inside and outside of the bladder.  This surgery may be somewhat difficult because of the inflammation of a chronically infected diverticulum.  Nevertheless treatment will usually have good results.  Postoperatively catheter drainage of the bladder is indicated for 1-2 weeks. 

Reviewed July, 2003

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Glossary Terms

benign:
	Not malignant; not cancerous.
bladder:
	The bladder is a thick muscular balloon-shaped pouch in which urine is stored before being discharged through the urethra.
BPH:
	Also known as benign prostatic hyperplasia. An enlarged prostate not caused by cancer. BPH can cause problems with urination because the prostate squeezes the urethra at the opening of the bladder.
catheter:
	A thin tube that is inserted through the urethra into the bladder to allow urine to drain or for performance of a procedure or test, such as insertion of a substance during a bladder X-ray.
chronic:
	Lasting a long time. Chronic diseases develop slowly. Chronic renal (kidney) failure may develop over many years and lead to end-stage renal (kidney) disease.
congenital:
	Present at birth.
cyst:
	An abnormal sac containing gas, fluid or a semisolid material. Cysts may form in kidneys or other parts of the body.
cystoscopy:
	Also known as cystourethroscopy. An examination with a narrow, flexible tube-like instrument passed through the urethra to examine the bladder and urinary tract for structural abnormalities or obstructions, such as tumors or stones.
diverticula:
	Plural of diverticulum. A pouch or sac in the lining of the mucous membrane of an organ.
diverticulum:
	A pouch or sac in the lining of the mucous membrane of an organ.
excision:
	Surgical cut.
hyperplasia:
	Excessive growth of normal cells of an organ.
infection:
	A condition resulting from the presence of bacteria or other microorganisms.
inflammation:
	Swelling, redness, heat and/or pain produced in the area of the body as a result of irritation, injury or infection.
ions:
	Electrically charged atoms.
kidney:
	One of two bean-shaped organs that filter wastes from the blood and discharge these waste products in urine. The kidneys are located on either side at the level of the 12th ribs toward the back. The kidneys send urine to the bladder through tubes called ureters.
prostatic:
	Pertaining to the prostate.
reflux:
	Backward flow of urine. Also referred to as vesicoureteral reflux (VUR). An abnormal condition in which urine backs up from the bladder into the ureters and occasionally into the kidneys, raising the risk of infection.
tumor:
	An abnormal mass of tissue or growth of cells.
ureter:
	One of two tubes that carry urine from the kidneys to the bladder.
ureteral:
	Pertaining to the ureter. Also referred to as ureteric.
ureterovesical junction:
	Also referred to as UVJ. Where the ureter meets the bladder.
urinary tract:
	The system that takes wastes from the blood and carries them out of the body in the form of urine. Passageway from the kidneys to the ureters, bladder and urethra.
urinary tract infection:
	Also referred to as UTI. An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract.
urine:
	Liquid waste product filtered from the blood by the kidneys, stored in the bladder and expelled from the body through the urethra by the act of urinating (voiding). About 96 percent of which is water and the rest waste products.
vas:
	Also referred to as vas deferens. The cordlike structure that carries sperm from the testicle to the urethra.

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