Diagnostic Ultrasound - Abdomen and Pelvis

Bladder Diverticulum
Diagnoses: Urinary Tract
– May occur anywhere
□ Most common near ureteric orifices
– Associated with syndromes
□ Prune-belly syndrome
□ Ehlers-Danlos
□ Menkes kinky-hair syndrome
□ Diamond-Blackfan syndrome
○ Congenital: Hutch diverticulum (40%)
– Weakness in detrusor muscle in paraureteral region
– Associated ± vesicoureteric reflux
• Associated abnormalities
○ Vesicoureteral reflux (VUR)
Gross Pathologic & Surgical Features
• Bladder mucosa and submucosa herniates through weak
areas in wall
• Typically located at areas of congenital weakness of
muscular wall at ureteral meatus or periureteral
(posterolateral) bladder wall
Microscopic Features
• Uroepithelial lining
Treatment
• Options, risks, complications
○ Complications
– Carcinoma
– Vesicoureteral reflux
– Ureteral obstruction
○ Indications for surgery
– Persistent infection
– Stone formation
– Ureteral obstruction
DIAGNOSTIC CHECKLIST
Consider
• Look for internal debris or filling defects, which may be
calculi, hematoma, or tumor
Image Interpretation Pearls
• Differentiated from pelvic cysts by demonstration of
diverticulum neck connecting to bladder in appropriate
plane
○ CTU or cystogram can help in differentiation
CLINICAL ISSUES
Presentation
• Most common signs/symptoms
○ Usually asymptomatic
• Other signs/symptoms
○ Hematuria due to complications
– Calculi
– Tumor due to chronic inflammation (in older patients)
○ Large fluid-filled diverticulum may present with pelvic
mass and may cause bladder outlet obstruction
• Clinical profile
○ Older male with benign prostatic hyperplasia (BPH)
○ Spinal cord injury patient (neurogenic bladder)
Demographics
• Age
○ 6th and 7th decade
• Gender
○ M:F = 9:1
• Epidemiology
○ Prevalence 1.7% in children
○ Multiple diverticula in children
– Neurogenic dysfunction
– Posterior urethral valves
– Prune belly syndrome
Natural History & Prognosis
• Wide neck diverticula
○ Empty readily with bladder
• Narrow neck diverticula
○ Urinary stasis → complications such as infection, stone
and ureteral obstruction
• Secondary inflammation predisposes to development of
carcinoma within diverticulum
• Tumors in diverticula have worse prognosis
○ Poorly formed wall and absence of muscle layer leads to
more rapid local invasion into surrounding perivesical fat
SELECTED REFERENCES
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obstetrics/gynecology ultrasound. Ultrasound Q. 28(4):293-8, 2012
4. Aslam F et al: Acute urinary retention as a result of a bladder diverticulum.
Int J Urol. 13(5):628-30, 2006
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Urol Nephrol. 37(3):473-5, 2005
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