Bladder diverticulum, a congenital disease of children and adults

Genetically all diverticula are congenital and arise from the zone between trigone and detrusor which is susceptible to embryonal disturbances. The climax of the morbidity is in the first and sixth decennium. In both cases, the diverticulum is caused by infravesical obstruction which is congenital in the first group and acquired in the second. The morbidity in the male patient is characteristically higher than in the female. Morphologically, we differentiate between small, medium sized and large diverticula with a gradually increasing morbidity, depending on the size of the diverticulum and involvement of the ipsilateral ureter. The musculature of the diverticular wall is deficient. Pathophysiologically, the growth of a diverticulum depends on three stimuli: an intrinsic one, the exposure to micturitional pressures and a coincidental infravesical obstruction. The micturition has lost its efficiency and is incomplete. The urine in the diverticulum empties incompletely into the urinary bladder. Correlated pathologies include reflux and tendencies towards chronic inflammation and malignant degeneration. Therapeutically, an endoscopic incision of a narrow diverticular neck should be considered first. If this is not sufficient diverticulectomy should be considered next and this is the treatment of choice for large diverticula. No treatment is necessary for small diverticula. If a paraostial diverticulum in children causes reflux of marked degree, the reflux should be operated on by an extravesical approach, sinking the diverticulum into the urinary bladder and eliminating the diverticulum this way.