Bladder diverticulum in young people is a condition where pouches form in the bladder wall, creating small bulges. While more commonly seen in older adults, it can also affect younger individuals. These pouches can develop due to weak spots in the bladder wall or obstruction of urine flow. Symptoms may include frequent urinary tract infections, difficulty urinating, or even blood in the urine.

Treatment options vary depending on the severity of symptoms and may include medication or, in more severe cases, surgery to remove the diverticula. Early diagnosis and management are crucial to prevent complications and improve quality of life.

Definition of bladder diverticula

Bladder diverticula are outpouchings or sacs that form in the bladder wall. These pouches create a pocket that can protrude from the bladder, similar to a hernia. Bladder diverticula can be congenital (present at birth) or acquired (develop later in life).

There are two types of bladder diverticula:

Congenital Diverticula: Main cause of this condition is incomplete development of the bladder wall.

• Present at birth and often result from a weakness in the bladder wall.
• Typically occur in children and young adults.
• May be associated with other congenital anomalies of the urinary tract.

Acquired Diverticula: Develop later in life, usually due to increased pressure within the bladder. Common causes include bladder outlet obstruction from conditions such as benign prostatic hyperplasia (BPH) in men or urethral stricture.

Causes of bladder diverticulum in young people

Bladder diverticulum in young people can arise from various causes, including:

• Congenital factors: Some individuals may be born with abnormalities in the structure or development of their bladder, making them more prone to diverticulum formation from an early age.
• Neurogenic bladder: Conditions affecting the nerves that control bladder function, such as spinal cord abnormalities or nerve damage, can lead to bladder diverticulum in young people.
• Bladder outlet obstruction: Obstruction in the urinary tract, such as from an enlarged prostate gland in males or urethral strictures, can cause increased pressure within the bladder, leading to the formation of diverticula.
• Chronic bladder inflammation or infection: Recurrent urinary tract infections or chronic inflammation of the bladder lining (cystitis) can weaken the bladder wall over time, predisposing young individuals to bladder diverticulum formation.
• Trauma: Bladder injuries, whether from accidents or medical procedures, can result in localized weakness of the bladder wall, potentially leading to diverticulum formation.
• Functional bladder disorders: Certain conditions affecting bladder function, such as dysfunctional voiding or overactive bladder, may contribute to the development of diverticula in young people.
• Rare genetic disorders: In some cases, rare genetic syndromes or conditions may be associated with bladder diverticulum formation in young individuals.

Symptoms

Bladder diverticulum is a condition where there is an outpouching of the bladder wall, creating a pouch or sac. In young people, symptoms can vary depending on the size and location of the diverticulum and whether there are complications. Common symptoms include:

• Recurrent Urinary Tract Infections (UTIs): Frequent infections due to urine stasis in the diverticulum.
• Voiding Difficulties: Difficulty in starting urination, weak urine stream, or incomplete bladder emptying.
• Hematuria: Presence of blood in the urine.
• Pelvic Pain: Discomfort or pain in the lower abdomen or pelvic area.
• Urinary Frequency and Urgency: Frequent need to urinate and a strong, sudden urge to urinate.
• Urinary Retention: Inability to completely empty the bladder, leading to residual urine.
• Incontinence: Unintentional loss of urine.

Diagnosis

Diagnosing bladder diverticulum in young people typically involves a combination of medical history, physical examination, and diagnostic tests. Here are the common steps and methods used for diagnosis:

• Medical History and Physical Examination: A thorough medical history to identify symptoms and risk factors. Physical examination to check for any signs of urinary abnormalities or related conditions.
  • Urinalysis: A test to check for signs of infection, blood, or other abnormalities in the urine.
  • Ultrasound: A non-invasive imaging test that uses sound waves to create images of the bladder and can detect the presence of diverticula.
  • Cystoscopy: A procedure in which a thin, flexible tube with a camera (cystoscope) is inserted through the urethra to visually inspect the bladder’s interior and identify any diverticula.
  • Voiding Cystourethrogram (VCUG): An X-ray test that involves filling the bladder with a contrast dye and taking images while the bladder fills and empties to visualize the diverticula and assess bladder function.
  • Computed Tomography (CT) Scan: A detailed imaging test that can provide comprehensive images of the bladder and surrounding structures to identify diverticula and any associated complications.
  • Magnetic Resonance Imaging (MRI): An imaging test that uses magnetic fields and radio waves to create detailed images of the bladder and can help in identifying diverticula.
  • Urodynamic Studies: Tests that measure how well the bladder and urethra store and release urine, which can help assess the impact of diverticula on bladder function.

Indications of treatment

Treatment of bladder diverticulum in young people is indicated based on the severity of symptoms, the presence of complications, and the underlying cause of the diverticulum. Here are the key indications for treatment:

• Recurrent Urinary Tract Infections (UTIs): Frequent UTIs due to urine stasis in the diverticulum.
  • Voiding Dysfunction: Difficulty urinating, incomplete bladder emptying, or urinary retention.
  • Hematuria: Persistent or recurrent blood in the urine.
  • Bladder Stones: Presence of stones in the diverticulum, which can cause pain, infection, and urinary obstruction.
  • Urinary Incontinence: Involuntary leakage of urine due to the diverticulum.
  • Bladder Outlet Obstruction: Obstruction caused by the diverticulum that impairs urine flow.
  • Significant Residual Urine: Large amounts of urine remaining in the bladder after urination, increasing the risk of infections and bladder damage.
  • Bladder Tumors: Presence of tumors within the diverticulum, which may require surgical intervention.
  • Symptomatic Diverticula: Significant symptoms such as pelvic pain, discomfort, or urinary urgency impacting quality of life.
  • Risk of Complications: Potential complications such as renal damage due to high bladder pressure or chronic infections.

Treatment

The treatment of bladder diverticulum in young people depends on several factors, including the severity of symptoms, the size and location of the diverticulum, and the underlying cause. Here are some common treatment options:

• Watchful waiting: In cases where the diverticulum is small and not causing significant symptoms, a conservative approach of monitoring without active intervention may be appropriate. Regular follow-up with a healthcare provider is important to monitor for any changes in symptoms or diverticulum size.
• Medication: If the diverticulum is associated with urinary tract infections or bladder inflammation, antibiotics or other medications may be prescribed to manage symptoms and prevent recurrent infections.
• Behavioral modifications: Making lifestyle changes such as avoiding caffeine and acidic foods, practicing bladder training techniques, and maintaining a healthy fluid intake can help alleviate symptoms associated with bladder diverticulum.
• Catheterization: In cases where there is bladder outlet obstruction or difficulty emptying the bladder, intermittent catheterization may be necessary to help empty the bladder completely and reduce the risk of complications such as urinary retention or recurrent infections.
• Surgery: Surgical intervention may be recommended for larger or symptomatic diverticula that do not respond to conservative measures. The type of surgery performed will depend on the size and location of the diverticulum but may include diverticulectomy (removal of the diverticulum), bladder wall reconstruction, or bladder augmentation.
• Endoscopic procedures: Minimally invasive procedures such as endoscopic incision or fulguration of the diverticulum may be considered in some cases, particularly for smaller diverticula or when surgery is not feasible.
• Management of underlying conditions: If bladder diverticulum is secondary to an underlying condition such as neurogenic bladder or bladder outlet obstruction, addressing the underlying cause is essential for effective management.

Summary

Bladder diverticulum in young people involves the formation of pouches in the bladder wall, which can lead to various symptoms like recurrent urinary tract infections, difficulty urinating, or blood in urine. Causes include congenital factors, bladder outlet obstruction, neurogenic bladder, inflammation, trauma, or rare genetic disorders. Treatment options range from watchful waiting and medication to surgery, depending on the severity and underlying cause. Regular monitoring by healthcare professionals is crucial for effective management and symptom relief.

Prof. Dr. Emin ÖZBEK

Urologist

Istanbul-TURKIYE