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.
Reviewed January 2011
