Bladder & urothelial tract
Other nonneoplastic
Diverticula
Author: Alcides Chaux, M.D.
Last author update: 1 July 2011
Last staff update: 23 November 2020
Copyright: 2003-2024, PathologyOutlines.com, Inc.
PubMed Search: Bladder diverticula
Table of Contents
Definition / general | Epidemiology | Sites | Etiology | Clinical features | Case reports | Treatment | Gross description | Gross images | Microscopic (histologic) descriptionCite this page: Chaux A. Diverticula. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladderdiverticula.html. Accessed April 19th, 2024.
Definition / general
- Outpouchings of urothelial mucosa through bladder muscular wall
Epidemiology
- > 90% in men, age range 1 - 81 years
- For cases with pathologic sampling, mean age is 55 years (Arch Pathol Lab Med 2009;133:791)
Sites
- Most diverticula are solitary lesions located in lateral walls of bladder
Etiology
- Congenital cases are due to bladder outlet obstruction or failure of muscle development (eMedicine: Surgery for Pediatric Bladder Anomalies [Accessed 11 July 2018])
- Acquired cases are more common and usually due to prostatic enlargement causing muscular hypertrophy and focal mucosal herniation without muscularis propria in areas of weakness, often near ureteral orifices, bladder dome or urethral orifice
Clinical features
- Most bladder diverticula are small and asymptomatic
- When symptomatic, usually associated with infections and stones (due to urine stasis), urinary retention or perforation
- Some cases are associated with additional GU anomalies (urethral strictures, neurogenic bladder, duplicated collecting system) or hereditable syndromes (Ehlers-Danlos, others)
- Malignancy occurs in 1 - 10% of bladder diverticula
- Tumors are often large because location is hidden
- All variants of urothelial carcinoma have been reported in bladder diverticula, with a relatively higher frequency of unusual subtypes when compared to the general population
Case reports
- 57 year old man with distended diverticulum causing colonic obstruction (World J Gastroenterol 2009;15:3957)
- 62 year old man with diverticulum due to chronic catheterization (Cases J 2009;2:36)
- 65 year old man with sarcomatoid carcinoma / carcinosarcoma in diverticulum (Arch Pathol Lab Med 2002;126:853)
- 90 year old woman with gastric metastasis to diverticulum (World J Surg Oncol 2005;3:55)
Treatment
- Varies by patient - nonoperative treatment, surgical bladder outlet reduction or removal of the diverticulum
Gross description
- Narrow necks, round / ovoid pouch from 1 - 18 cm (average 5.0 cm)
Gross images
Images hosted on other servers:
Image with case history
Microscopic (histologic) description
Nonneoplastic findings
Neoplastic findings
- Wall consists of fibrous tissue with no / scant muscularis propria
- Common findings include inflammation, granulation tissue formation, erosion, cystitis cystica et glandularis, nonkeratinizing squamous metaplasia, reactive urothelial atypia
Neoplastic findings
- Most neoplastic lesions that arise in bladder diverticula are urothelial carcinomas, mainly noninvasive papillary (high / low grade) or invasive
