Top

01-02-2025 | Diverticulitis | Review

Urinary bladder diverticula: imaging features and complications

Authors: Grace G. Zhu, Cary L. Siegel, Douglas M. Rogers, Jonathan Sagel, Glen Morrell, Jeffrey D. Olpin, Bogdana Schmidt, Mark J. Hoegger

Published in: Abdominal Radiology

Abstract

Urinary bladder diverticula are common and are frequently incidentally discovered. Many downstream complications can occur due to urinary stasis, such as bladder diverticular stones, infection, and malignancy. Understanding the physiology of bladder diverticula and potential pitfalls and mimics is critical to an accurate description of bladder diverticula and early detection of potential downstream complications. This pictorial review will first review the normal bladder histology and function, bladder diverticular types, and typical imaging features. The paper will then draw attention to technical pitfalls and potential mimics. Finally, we will review the downstream complications, including stones, infection, malignancy, and BCG-related changes.

Graphical abstract

Available only for authorised users

Kong MX, Zhao X, Kheterpal E, Lee P, Taneja S, Lepor H, Melamed J, Deng FM (2013) Histopathologic and clinical features of vesical diverticula. Urology 82 (1):142-147. https://doi.org/10.1016/j.urology.2013.02.015CrossRefPubMed

Melekos MD, Asbach HW, Barbalias GA (1987) Vesical diverticula: etiology, diagnosis, tumorigenesis, and treatment. Analysis of 74 cases. Urology 30 (5):453-457. https://doi.org/10.1016/0090-4295(87)90378-5CrossRefPubMed

Hoegger MJ, Strnad BS, Ballard DH, Siegel CL, Shetty AS, Weimholt RC, Yano M, Stanton ML, Mellnick VM, Kawashima A, Zulfiqar M (2023) Urinary Bladder Masses, Rare Subtypes, and Masslike Lesions: Radiologic-Pathologic Correlation. Radiographics 43 (1):e220034. https://doi.org/10.1148/rg.220034CrossRefPubMed

Fry CH, Vahabi B (2016) The Role of the Mucosa in Normal and Abnormal Bladder Function. Basic Clin Pharmacol Toxicol 119 Suppl 3 (Suppl 3):57-62. https://doi.org/10.1111/bcpt.12626CrossRefPubMed

Acharya P, Beckel J, Ruiz WG, Wang E, Rojas R, Birder L, Apodaca G (2004) Distribution of the tight junction proteins ZO-1, occludin, and claudin-4, -8, and -12 in bladder epithelium. Am J Physiol Renal Physiol 287 (2):F305-318. https://doi.org/10.1152/ajprenal.00341.2003CrossRefPubMed

Jafari NV, Rohn JL (2022) The urothelium: a multi-faceted barrier against a harsh environment. Mucosal Immunol 15 (6):1127-1142. https://doi.org/10.1038/s41385-022-00565-0CrossRefPubMedPubMedCentral

Idrees MT, Alexander RE, Kum JB, Cheng L (2013) The spectrum of histopathologic findings in vesical diverticulum: implications for pathogenesis and staging. Hum Pathol 44 (7):1223-1232. https://doi.org/10.1016/j.humpath.2012.11.005CrossRefPubMed

Blane CE, Zerin JM, Bloom DA (1994) Bladder diverticula in children. Radiology 190 (3):695-697. https://doi.org/10.1148/radiology.190.3.8115613CrossRefPubMed

Gkalonaki I, Anastasakis M, Panteli C, Patoulias I (2022) Hutch diverticulum: from embryology to clinical practice. Folia Med Cracov 62 (4):57-62. https://doi.org/10.24425/fmc.2022.144083CrossRefPubMed

10.

Parada Villavicencio C, Adam SZ, Nikolaidis P, Yaghmai V, Miller FH (2016) Imaging of the Urachus: Anomalies, Complications, and Mimics. RadioGraphics 36 (7):2049-2063. https://doi.org/10.1148/rg.2016160062CrossRefPubMed

11.

Halaseh SA LS (2023) Bladder Diverticulum. StatPearls [Internet]. StatPearls Publishing, Treasure Island (FL)

12.

Jiang S, Ren Q, Wang X, Yang G, Wei S, Zhao Q, Xu H (2020) A huge bladder diverticulum in an elderly: A case report. SAGE Open Med Case Rep 8:2050313x20943475. https://doi.org/10.1177/2050313x20943475

13.

Wein AJ, Kavoussi LR, Novick AC, Partin AW, Peters CA (2011) Campbell-Walsh urology: expert consult premium edition: enhanced online features and print, 4-volume set. Elsevier Health Sciences,

14.

Bogdanos J, Paleodimos I, Korakianitis G, Stephanidis A, Androulakakis PA (2005) The large bladder diverticulum in children. Journal of Pediatric Urology 1 (4):267-272. https://doi.org/10.1016/j.jpurol.2005.01.005CrossRefPubMed

15.

Garat JM, Angerri O, Caffaratti J, Moscatiello P, Villavicencio H (2007) Primary congenital bladder diverticula in children. Urology 70 (5):984-988. https://doi.org/10.1016/j.urology.2007.06.1108CrossRefPubMed

16.

Walker NF, Gan C, Olsburgh J, Khan MS (2014) Diagnosis and management of intradiverticular bladder tumours. Nature Reviews Urology 11 (7):383-390. https://doi.org/10.1038/nrurol.2014.131CrossRefPubMed

17.

Gerridzen RG, Futter NG (1982) Ten-year review of vesical diverticula. Urology 20 (1):33-35. https://doi.org/10.1016/0090-4295(82)90532-5CrossRefPubMed

18.

Afshar K, Malek R, Bakhshi M, Papanikolaou F, Farhat W, Bagli D, Khoury AE, Pippi-Salle JL (2005) Should the presence of congenital para-ureteral diverticulum affect the management of vesicoureteral reflux? J Urol 174 (4 Pt 2):1590-1593. https://doi.org/10.1097/01.ju.0000175515.25334.0eCrossRefPubMed

19.

Amar AD (1972) Vesicoureteral reflux associated with congenital bladder diverticulum in boys and young men. J Urol 107 (6):966-968. https://doi.org/10.1016/s0022-5347(17)61184-4CrossRefPubMed

20.

Tan S, Sakaria S (2020) Bladder Diverticulum-A Case Report. J Educ Teach Emerg Med 5 (4):V15-v18. https://doi.org/10.21980/j8635cCrossRefPubMedPubMedCentral

21.

El-Agwany AS (2022) Anterior bladder diverticulum: diagnostic dilemma in gynecological and urological practice. Ultrasound in Obstetrics & Gynecology 59 (5):695-696. https://doi.org/10.1002/uog.24788CrossRef

22.

Levine D, Filly RA (1994) Using color Doppler jets to differentiate a pelvic cyst from a bladder diverticulum. J Ultrasound Med 13 (7):575-577. https://doi.org/10.7863/jum.1994.13.7.575CrossRefPubMed

23.

Suzuki K, Tanaka O, Saito T, Tokue A (2002) Giant bladder diverticulum due to previous bullet injury: findings of gadolinium-enhanced magnetic resonance imaging. Int J Urol 9 (9):517-519; discussion 520. https://doi.org/10.1046/j.1442-2042.2002.00509.x

24.

Girish G, Chooi WK, Morcos SK (2004) Filling defect artefacts in magnetic resonance urography. Eur Radiol 14 (1):145-150. https://doi.org/10.1007/s00330-003-1986-5CrossRefPubMed

25.

Higgins JJ, Urbine JA, Malik A (2022) Beyond reflux: the spectrum of voiding cystourethrogram findings in the pediatric population. Pediatr Radiol 52 (1):134-143. https://doi.org/10.1007/s00247-021-05161-1CrossRefPubMed

26.

Sow O, Sarr A, Ze Ondo C, Sine B, Ndiath A, Ndoye AK (2021) Giant bladder diverticulum in a postmenopausal woman: Case report and literature review. Urology Case Reports 39:101807. https://doi.org/10.1016/j.eucr.2021.101807CrossRefPubMedPubMedCentral

27.

Valadez R, Maizels M, Fernbach SK (1987) Lower extremity cyanosis: an unusual presentation of congenital paraureteral diverticula. J Urol 138 (2):364-365. https://doi.org/10.1016/s0022-5347(17)43147-8CrossRefPubMed

28.

Favorito LA (2018) Bladder diverticula with more than 5 cm increases the risk of acute urinary retention in BPH. Int Braz J Urol 44 (4):662-663. https://doi.org/10.1590/s1677-5538.Ibju.2018.04.01CrossRefPubMedPubMedCentral

29.

Silberman M, Jeanmonod R (2011) Bladder diverticulitis: a case report. Case Rep Emerg Med 2011:303498. https://doi.org/10.1155/2011/303498CrossRefPubMedPubMedCentral

30.

Wosnitzer B (2012) Bladder diverticulitis on PET/CT. Radiol Case Rep 7 (2):673. https://doi.org/10.2484/rcr.v7i2.673CrossRefPubMed

31.

Tan MO, Yam WL, Tan YK, Chia SJ, Ng KS (2020) A Rare Case of Acute Urinary Bladder Diverticulitis Mimicking Acute Appendicitis. Am J Case Rep 21:e925236. https://doi.org/10.12659/ajcr.925236CrossRefPubMedPubMedCentral

32.

Hill AJ, Basourakos SP, Lewicki P, Wu X, Arenas-Gallo C, Chuang D, Bodner D, Jaeger I, Nevo A, Zell M, Markt SC, Eisner BH, Shoag JE (2022) Incidence of Kidney Stones in the United States: The Continuous National Health and Nutrition Examination Survey. J Urol 207 (4):851-856. https://doi.org/10.1097/ju.0000000000002331CrossRefPubMed

33.

Martin SP (1918) DUMB-BELL STONE IN DIVERTICULUM OF URINARY BLADDER. Ann Surg 67 (1):94-95. https://doi.org/10.1097/00000658-191801000-00011CrossRefPubMedPubMedCentral

34.

Bartel P, Krebs J, Wöllner J, Göcking K, Pannek J (2014) Bladder stones in patients with spinal cord injury: a long-term study. Spinal Cord 52 (4):295-297. https://doi.org/10.1038/sc.2014.1CrossRefPubMed

35.

Jung JH, Park J, Kim WT, Kim HW, Kim HJ, Hong S, Yang HJ, Chung H (2018) The association of benign prostatic hyperplasia with lower urinary tract stones in adult men: A retrospective multicenter study. Asian J Urol 5 (2):118-121. https://doi.org/10.1016/j.ajur.2017.06.008CrossRefPubMed

36.

Federle MP, McAninch JW, Kaiser JA, Goodman PC, Roberts J, Mall JC (1981) Computed tomography of urinary calculi. AJR Am J Roentgenol 136 (2):255-258. https://doi.org/10.2214/ajr.136.2.255CrossRefPubMed

37.

Douenias R, Rich M, Badlani G, Mazor D, Smith A (1991) Predisposing factors in bladder calculi. Review of 100 cases. Urology 37 (3):240-243. https://doi.org/10.1016/0090-4295(91)80293-gCrossRefPubMed

38.

Fox M, Power RF, Bruce AW (1962) DIVERTICULUM OF THE BLADDER–PRESENTATION AND EVALUATION OF TREATMENT OF 115 CASES. British Journal of Urology 34 (3):286-298. https://doi.org/10.1111/j.1464-410X.1962.tb09459.xCrossRefPubMed

39.

Kelalis PP, McLean P (1967) The treatment of diverticulum of the bladder. J Urol 98 (3):349-352. https://doi.org/10.1016/s0022-5347(17)62888-xCrossRefPubMed

40.

Kumar Sah A, Maharjan B, Adhikari MB, Rana R, Basnet S, Panta R, Aryal G (2021) Radical Cystectomy for Intradiverticular Bladder Carcinoma: A Case Report. Journal of Nepal Medical Association 59 (242):1069-1071. https://doi.org/10.31729/jnma.6228CrossRef

41.

Poletajew S, Krajewski W, Adamowicz J, Kołodziej A, Zdrojowy R, Radziszewski P (2020) Management of Intradiverticular Bladder Tumours: A Systematic Review. Urol Int 104 (1-2):42-47. https://doi.org/10.1159/000503868CrossRefPubMed

42.

Montague DK, Boltuch RL (1976) Primary neoplasms in vesical diverticula: report of 10 cases. J Urol 116 (1):41-42. https://doi.org/10.1016/s0022-5347(17)58664-4CrossRefPubMed

43.

Di Paolo PL, Vargas HA, Karlo CA, Lakhman Y, Zheng J, Moskowitz CS, Al-Ahmadie HA, Sala E, Bochner BH, Hricak H (2015) Intradiverticular bladder cancer: CT imaging features and their association with clinical outcomes. Clin Imaging 39 (1):94-98. https://doi.org/10.1016/j.clinimag.2014.10.004CrossRefPubMed

44.

Jackson AM, Alexandroff AB, Kelly RW, Skibinska A, Esuvaranathan K, Prescott S, Chisholm GD, James K (1995) Changes in urinary cytokines and soluble intercellular adhesion molecule-1 (ICAM-1) in bladder cancer patients after bacillus Calmette-Guérin (BCG) immunotherapy. Clin Exp Immunol 99 (3):369-375. https://doi.org/10.1111/j.1365-2249.1995.tb05560.xCrossRefPubMedPubMedCentral

45.

Gandhi NM, Morales A, Lamm DL (2013) Bacillus Calmette-Guérin immunotherapy for genitourinary cancer. BJU Int 112 (3):288-297. https://doi.org/10.1111/j.1464-410X.2012.11754.xCrossRefPubMed

46.

Lamm DL, van der Meijden PM, Morales A, Brosman SA, Catalona WJ, Herr HW, Soloway MS, Steg A, Debruyne FM (1992) Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer. J Urol 147 (3):596-600. https://doi.org/10.1016/s0022-5347(17)37316-0CrossRefPubMed

47.

Ma W, Kang SK, Hricak H, Gerst SR, Zhang J (2009) Imaging appearance of granulomatous disease after intravesical Bacille Calmette-Guerin (BCG) treatment of bladder carcinoma. AJR Am J Roentgenol 192 (6):1494-1500. https://doi.org/10.2214/ajr.08.1962CrossRefPubMed

48.

Green DB, Kawashima A, Menias CO, Tanaka T, Redelman-Sidi G, Bhalla S, Shah R, King BF (2018) Complications of Intravesical BCG Immunotherapy for Bladder Cancer. RadioGraphics 39 (1):80-94. https://doi.org/10.1148/rg.2019180014CrossRefPubMed

Title: Urinary bladder diverticula: imaging features and complications
Authors: Grace G. Zhu
Cary L. Siegel
Douglas M. Rogers
Jonathan Sagel
Glen Morrell
Jeffrey D. Olpin
Bogdana Schmidt
Mark J. Hoegger
Publication date: 01-02-2025
Publisher: Springer US
Keyword: Diverticulitis
Published in: Abdominal Radiology
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI: https://doi.org/10.1007/s00261-024-04714-w

Keynote series | Spotlight on menopause

Menopause
Video Series

Menopause can have a significant impact on the body, with effects ranging beyond the endocrine and reproductive systems. Learn about the systemic effects of menopause, so you can help patients in your clinics through the transition.

Prof. Martha Hickey

Dr. Claudia Barth

Dr. Samar El Khoudary

Developed by: Springer Medicine

Watch now

Keynote webinar | Spotlight on adolescent vaping

Pediatrics
On-demand webinar

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Prof. Ann McNeill

Dr. Debbie Robson

Benji Horwell

Developed by: Springer Medicine

Watch now

Keynote webinar | Spotlight on modern management of frailty

Frailty in Geriatric Patients
On-demand webinar

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft

Prof. Barbara C. van Munster

Prof. Mirko Petrovic

Developed by: Springer Medicine

Watch now

A quick guide to ECGs

Electrocardiography
Training Course

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date.

PD Dr. Carsten W. Israel

Developed by: Springer Medizin

Start the cases

At a glance: The STEP trials

Obesity
Clinical Trial Summary

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote series | Spotlight on menopause

Springer Medicine

Abstract

Graphical abstract

Please log in to get access to this content

Keynote series | Spotlight on menopause

Keynote webinar | Spotlight on adolescent vaping

Keynote webinar | Spotlight on modern management of frailty

A quick guide to ECGs

At a glance: The STEP trials