The Urology Group of Princeton is pleased to share this informative article on bladder diverticulum courtesy of the Urology Care Foundation.
What is a Bladder Diverticulum?
A bladder diverticulum is a pouch in the bladder wall that a person may either be born with (“congenital”) or get later (“acquired”).
A congenital bladder diverticulum forms when some of the bladder lining pokes through a weak part in the bladder wall. A congenital diverticulum is most often found when you are still a child, and there is often only 1 pouch. They often don’t need to be treated.
Acquired bladder diverticula (more than 1 diverticulum) are most often caused by a block in the bladder outlet (such as from a swollen prostate or scars in the urethra), the bladder not working well because of nerve injury or, rarely, from prior bladder surgery. With acquired diverticula, many pouches often form. These are most often seen in older men, who tend to get bladder outlet blocks more often.
How Does the Bladder Usually Work?
The bladder is a balloon-shaped organ that stores urine, which is made in the kidneys. It is held in place by pelvic muscles in the lower part of your bell. When it isn’t full, the bladder is relaxed. Muscles in the bladder wall allow it to expand as it fills with urine. Nerve signals in your brain let you know that your bladder is getting full. Then you feel the need to go to the bathroom. The brain tells the bladder muscles to squeeze (or “contract”). This forces the urine out of your body through your urethra.
Most often, bladder diverticula have no direct signs. They are found while looking for causes of other urinary problems.
Some problems bladder diverticula can be linked to are:
- urinary tract infections
- bladder stones
- urine flowing backwards into the kidneys (“reflux”)
- bladder tumors
- trouble peeing
Bladder diverticula can be found with an x-ray test of the bladder. The test is done by filling the bladder with a dye that shows up well in x-rays (called a “contrast”) and taking pictures. Your health care provider may also look into your bladder with a cystoscope, a long, thin telescope with a light at the end. This is to check for bladder tumors in the diverticulum. A pressure test called “urodynamics” may also be done to see how well the bladder works and check for blocks. Your health care provider may use ultrasound, which takes pictures of your organs by bouncing sound waves off them, to see how any blocks affect your kidneys.
Bladder diverticula don’t always need to be treated if they’re not causing any problems. Diverticula caused by a block in the bladder are treated by taking out the block and maybe the diverticulum, as well. The surgery can be done by open surgery or through small tubes fed inside the bladder. A robot may be used to help with the surgery. Sometimes surgery on the outside of the bladder will also be needed. This surgery may be hard if the diverticulum has been infected and is swollen. For patients who can’t have open surgery, the opening of the diverticulum into the bladder can be made larger. Samples of any tumors found in a diverticulum are tested for cancer.
Treatment often works and may help your symptoms. In some cases, after the cause of the diverticulum (such as a block in the bladder) is fixed, you won’t need to be treated further. Your health care provider may want to check the diverticulum with a cystoscope through the urethra once in a while.
After surgery, you will need to have a catheter to drain your bladder for 1 or 2 weeks.
Some rare risks of diverticulum surgery are:
- damage to the intestines or ureters (the tubes that carry urine from the kidneys)
- urine leaking from the bladder after surgery
Some patients will need to have the diverticulum removed with open surgery later. If your bladder doesn’t work well, you may need to help drain it with a catheter.
For more information or to address any urology-related concerns, please call the office (609.924.6487) to schedule a consultation and exam.
Photo courtesy of Danie Franco.