Editing Bladder Diverticulae (section)

== Classification ==

* '''<span style="color:#ff0000">Classified as congenital vs. acquired'''

=== Congenital ===
* '''Thought to be a congenital weakness of the detrusor muscle'''
* '''Majority''' (≈90%) '''located near ureterovesical junction''', '''usually lateral and posterior to ureteral orifice''' with or without coexistent lower urinary tract abnormalities
** ≈13% have '''associated vesicoureteral reflux (VUR)'''
* '''Usually present during childhood'''
* '''Most common presentation:''' acute '''UTI''' resulting from stasis
** Less common presentations include enuresis, pyelonephritis, acute retention, and stones.
* '''May occur in the presence of normal voiding dynamics and in the absence of bladder outlet obstruction;''' '''however, up to 60% of congenital bladder diverticula may be associated with an underlying syndrome''' (Menkes syndrome, Williams syndrome, Ehlers-Danlos syndrome, and fetal alcohol syndrome), '''neuropathic voiding dysfunction, or outlet obstruction'''
** It has been suggested that chromosomal testing should be pursued in such patients; however, this testing is generally not recommended in children with a single simple lesion
* '''Typically, found in smooth-walled bladders''' '''and are not associated with significant trabeculation'''
* Importantly, unlike secondary or adult bladder diverticula, there is virtually '''no increased association with malignancy''' in congenital diverticula

=== Acquired ===
* '''<span style="color:#ff0000">Coexistent lower urinary tract neurogenic dysfunction or obstruction is almost always present'''
** '''In males, usually occurs after age 60''' (corresponds with age of clinically significant prostatic enlargement); '''≈70% associated with BPH'''
** '''In females, relatively uncommon''' '''and often associated with bladder outlet obstruction'''
*** '''When found in the female, careful evaluation will often reveal a cause for obstruction such as dysfunctional voiding, vaginal prolapse, bladder neck hypertrophy, urethral stricture, or iatrogenic obstruction resulting from anti-incontinence surgery'''
** '''May be found in children and young adults''' '''secondary to conditions such as bladder neck dysfunction, posterior urethral valves, and neurogenic vesicourethral dysfunction'''
** '''May be iatrogenic'''; inadequate closure of the muscular layers of the bladder wall following a cystotomy for any indication may result in formation of a bladder diverticulum at a weak point of the suture line
* '''Often multiple, typically found in association with significant bladder trabeculation'''
* '''Usually located near ureterovesical junction (similar to congenital) but also occur elsewhere in the bladder.'''
** '''“Hutch” diverticulum: a diverticulum located superolateral to the ureteral orifice, without involving the trigone in the setting of a neuropathic bladder and vesicoureteral reflux'''
*** Named after the individual who described this finding in a series of paraplegic individuals
* '''<span style="color:#ff0000">Association with increased risk of malignancy'''
** '''Most common histology of malignancy in bladder diverticulum: urothelial carcinoma'''