What is bladder diverticulitis?

Bladder Diverticulitis: Definition, Diagnosis, and Management

Bladder diverticulitis is an extremely rare inflammatory condition affecting a bladder diverticulum (an outpouching of the bladder wall), which can cause symptoms mimicking other acute abdominal conditions and may lead to serious complications including recurrent urinary tract infections.

Definition and Pathophysiology

Bladder diverticula are outpouchings of the bladder wall that occur either congenitally or as a result of bladder outlet obstruction. While bladder diverticula themselves are relatively common, inflammation of these diverticula (bladder diverticulitis) is extremely rare, unlike colonic diverticulitis which is much more common 1.

Key characteristics include:

• Inflammation of a bladder diverticulum (outpouching of bladder wall)
• May occur in patients with chronic bladder outlet obstruction
• Can cause focal inflammation along the bladder wall
• Often presents with hematuria, similar to how colonic diverticulitis presents with rectal bleeding

Clinical Presentation

Patients with bladder diverticulitis may present with:

• Abdominal or pelvic pain (can mimic other conditions like appendicitis depending on location) 1
• Hematuria (blood in urine) 1
• Fever and signs of infection 2
• Urinary symptoms including frequency, urgency, or retention
• Elevated post-void residual 2
• Abnormal urinalysis showing inflammation 2

Diagnosis

Diagnosis of bladder diverticulitis requires imaging studies and clinical correlation:

1. CT Scan with Contrast: The gold standard for diagnosis, showing:

   • Bladder diverticulum with wall thickening
   • Inflammatory changes around the diverticulum
   • Possible abscess formation

2. Point-of-Care Ultrasound: Can be used for rapid initial assessment 2

   • Can identify bladder diverticula
   • May show inflammatory changes
   • Useful for measuring post-void residual

3. Cystoscopy: Important for evaluation of the bladder and diverticulum 1

   • Allows direct visualization of the diverticulum
   • Can assess for other bladder pathology

4. Urodynamic Studies: Should be performed to evaluate for underlying bladder outlet obstruction 1

   • May reveal chronic outlet obstruction even in patients without lower urinary tract symptoms

Differential Diagnosis

Bladder diverticulitis can mimic several other conditions:

• Acute appendicitis (especially when located on right side) 1
• Colonic diverticulitis
• Urinary tract infection
• Pelvic inflammatory disease
• Bladder tumor

Management

Treatment approach depends on severity:

1. Conservative Management:

   • Antibiotics targeting urinary pathogens
   • Pain management
   • Hydration
   • Treatment of any underlying bladder outlet obstruction

2. Surgical Management:

   • Indicated for recurrent infections, large diverticula, or complications
   • Options include diverticulectomy (removal of the diverticulum)
   • Can be performed via open, laparoscopic, or robotic approaches 3
   • Timing of intervention requires careful consideration 3

3. Treatment of Underlying Causes:

   • Management of bladder outlet obstruction (e.g., prostate enlargement)
   • Treatment of any contributing factors

Complications

Potential complications of bladder diverticulitis include:

• Recurrent urinary tract infections 2
• Abscess formation
• Perforation
• Fistula formation
• Sepsis in severe cases

Follow-up

After an episode of bladder diverticulitis:

• Urological evaluation is essential
• Cystoscopy to evaluate the bladder and diverticulum
• Urodynamic studies to assess for bladder outlet obstruction
• Regular follow-up to monitor for recurrence

Key Distinctions from Colonic Diverticulitis

While colonic diverticulitis is common and well-characterized 4, bladder diverticulitis is extremely rare with poorly understood etiology 1. The management principles differ significantly, with bladder diverticulitis requiring urological rather than gastrointestinal expertise.

Unlike colonic diverticulitis which has established classification systems (such as Hinchey classification) 4, bladder diverticulitis does not have standardized staging or classification systems due to its rarity.