Editing Pediatrics: Bladder Anomalies (section)

=== Bladder Diverticulum ===
* Can be detected on prenatal ultrasound, but the gold standard remains VCUG, which will reveal possible accompanying VUR.
* Caused by infravesical obstruction, iatrogenic after bladder surgery, or as a congenital defect. Independent from the cause, all diverticula develop as herniation of bladder mucosa between defects of bladder smooth muscle fibers. The neck of the resulting diverticulum depends on the size of the muscular defect
* Primary paraureteral diverticula are seen in smooth-walled bladders, occur isolated with no other diverticula, are intermittent in manifestation, happen in children with no infravesical obstruction, and are most likely caused by a congenitally deficient bladder wall
* Secondary paraureteral diverticula are acquired, found in trabeculated bladders as one of many diverticula in the bladder, are always present, and are caused by infravesical obstruction.
* '''Congenital diverticula are often found in children with generalized connective tissue diseases such as Ehlers-Danlos, Williams elfin-facies, or Menkes syndrome'''
* '''Paraureteral diverticula or diverticula located in the lower part of the bladder can become so large that they compress the bladder neck or posterior urethra. The resulting bladder outlet obstruction starts a vicious circle by continuously filling and expanding the diverticulum. This increases the obstructing and subsequently causes complete urinary retention'''
* '''Small, asymptomatic congenital diverticula detected during unrelated workups can be treated conservatively with regular observation.'''
* '''In acquired bladder diverticula, the infravesical obstruction has to be eliminated first. After bladder outlet resistance is normalized, the bladder can reshape and diverticulectomy might become unnecessary.''' If symptomatic, especially in conjunction with VUR, the diverticulum should be excised.