Bladder Diverticula

General Considerations

• Uncommon
• May be congenital or acquired
  • Congenital (Hutch diverticula) are usually solitary
• More common in males
• Acquired arise from obstruction, infection or are iatrogenic
• More common than congenital
• Multiple
• Bladder is usually trabeculated
• Congenital arise from herniation of the mucosa through the musculature of the bladder wall
• Can become larger than bladder
• Usually occur lateral and superior to openings of ureters
• Single diverticula on one or both sides of bladder may be an incidental finding but multiple diverticula on the same side suggests an underlying condition 

Clinical Findings

• Usually asymptomatic
• When symptomatic, may present with UTI
• Rarely a cause of bladder outlet obstruction 

Imaging Findings

• Voiding cystourethrogram (VCUG) is imaging modality most frequently used
• Ultrasound may demonstrate larger diverticula
• Narrow-mouthed diverticula will drain slowly and are more prone to stasis and infection than are wide-mouthed
• Congenital form are most often adjacent to ureteral orifice and are more often wide-mouthed
• Will enlarge as bladder is emptied
• May occur on dome of bladder in bladder outlet obstruction or Eagle Barrett Syndrome (prune belly syndrome) 

Differential Diagnosis

• Bladder ears
  • Protrude through internal inguinal ring
• More often seen in children than adults
• Seen most often when bladder is maximally distended
• Will empty when bladder is emptied (diverticula tend to fill when bladder is emptied)
• Bladder diverticula occur in William’s syndrome
• Also hypercalcemia and aortic and other stenoses
• Ehlers-Danlos syndrome, Menkes syndrome also have higher incidence of bladder diverticula 

Treatment

• If secondary to bladder outlet obstruction, remove the obstruction
  • Diverticula tend to regress in size
• If congenital, they are removed surgically
  • If they cause obstruction, there are recurrent UTI, reflux or stone formation

Complications

• Infection
• Stones
• Epithelial dysplasia
• Vesicoureteral reflux (more common)
• Ureteral obstruction (very rare)
• Bladder outlet obstruction (very rare) 

Prognosis

• Excellent