Management of Bladder Diverticula

Bladder diverticula can be congenital or acquired. In adults, they are typically associated with bladder outlet obstruction but may also have iatrogenic causes; they are occasionally associated with bladder cancer. Although they are common in men with bladder obstruction, most diverticula are small and require no treatment other than that required for the outlet obstruction. Indications for surgery include recurrent urinary tract infections, stones, tumors, ureteral obstruction, and symptomatic incomplete bladder emptying. The type of surgery depends on a clear understanding of the degree to which the bladder diverticulum contributes to the patient's condition based on cystoscopy, urodynamics, and upper tract imaging. Because of the increased incidence of bladder cancer, routine surveillance with cystoscopy and cytology has been recommended by some experts, but there are no clear guidelines regarding this. Surgical techniques in the management of bladder diverticula are evolving, especially with laparoscopy and robotics.