Bladder Diverticulum

Bladder diverticulum is a condition in children where a small pouch forms in the bladder wall due to a weakness between the detrusor muscle fibers. It can be congenital (something babies are born with) due to incomplete bladder wall development or acquired over time, often due to increased pressure within the bladder due to obstruction. A congenital bladder diverticulum is usually diagnosed before the age of ten, while acquired types are most common in patients over the age of 60, as they are prone to obstruction due to BPH.

Congenital causes have a single herniation or diverticulum, while acquired cases usually have multiple herniations or diverticula.

Only about 10% of all bladder diverticula occur in children, with most cases affecting adults. This condition is nine times more prevalent in boys than girls.

Symptoms of Bladder Diverticulum

  • Frequent urinary tract infections
  • Blood in urine (hematuria)
  • Painful urination (dysuria)
  • Lower abdominal pain or a feeling of fullness
  • Difficulty completely emptying the bladder
  • Abdominal distension
  • Urinary retention

Diagnosis

Diagnosis of bladder diverticulum in pediatric patients starts with a detailed medical history and physical examination. Your pediatric urologist will order urine tests, which include analysis and culture of the urine sample. Imaging studies such as an ultrasound, voiding cystourethrogram, or MRI of the urinary tract may also be ordered. Sometimes, your doctor may need a cystoscopy (a procedure that uses a scope) to examine the inside of the bladder and visualize the concern.

Treatment

Depending on your child’s symptoms and medical history, there are conservative and surgical treatment options that your doctor may recommend.

Conservative Management

Includes regular monitoring and follow-up for children with little or no symptoms.

Surgical Intervention

This includes open or laparoscopic diverticulectomy to remove the diverticulum. Laparoscopy is performed by creating small cuts in the abdomen to allow access to the laparoscope, camera, and other surgical tools. Robotic-assisted surgery can be employed for precise, minimally invasive procedures. Open surgery is performed through a small hidden incision below the underwear line.

Endoscopic methods with cystoscopy include fulguration (burning away) and resection (cutting away) of problematic tissue.

Follow Up

Children with bladder diverticulum need regular follow-up to monitor for complications like urinary infections or difficulty with urination. Awareness of new symptoms is essential for early detection and intervention.

Resources:

  1. Nerli RB, Ghagane SC, Musale A, et al. Congenital bladder diverticulum in a child: Surgical steps of extra-vesical excision. Urology Case Reports. 2019;22:42-43. doi:https://doi.org/10.1016/j.eucr.2018.10.009
  2. Halaseh SA, Leslie SW. Bladder Diverticulum. PubMed. Published 2022. https://www.ncbi.nlm.nih.gov/books/NBK580557/