Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Diagnosis and management of intradiverticular bladder tumours

Nature Reviews Urology volume 11, pages 383–390 (2014)Cite this article

Subjects

Key Points

  • Intradiverticular bladder tumours (IDBT) are rare, accounting for approximately 1% of all bladder tumours; the true prevalence of bladder diverticula is not known as most are asymptomatic

  • Urine cytology, ultrasonography, and cystoscopy should be used in the initial assessment of a suspected IDBT; cross-sectional imaging can complement these techniques, and is also important in staging

  • Bladder-conserving treatments including transurethral resection, diverticulectomy, or partial cystectomy with or without intravesical adjuvant therapy can be used in patients with low-grade, low-volume, noninvasive disease

  • Radical cystectomy, with or without systemic neoadjuvant or adjuvant therapy, is required for patients with large, invasive tumours, or tumours that are associated with poor bladder function (chronic retention)

  • 5-year survival rates of 72% and 45% have been reported for patients with IDBT and, specifically, T3 IDBTs, respectively; these rates are comparable to those for intravesical bladder cancer

Abstract

Intradiverticular bladder tumours (IDBT) account for approximately 1% of all urinary bladder tumours. The risk of developing a tumour within a bladder diverticulum is considered to be greater than in the main bladder, possibly owing to prolonged contact of potential carcinogens with the mucosal lining from urinary stasis. Patients with these tumours most commonly present with visible haematuria. Diagnostic tests include urine cytology, cystoscopy, ultrasonography, CT, MRI, and biopsy. Lack of muscle in the diverticula increases the risk of bladder perforation during biopsy and makes pathological staging difficult as there is no T2 stage; instead, data suggest that any invasion beyond the lamina propria should be described as T3. IDBT can be managed by transurethral resection and adjuvant intravesical therapy, diverticulectomy, or cystectomy (partial or radical), as outlined by the only guidelines to specifically address the management of IDBT, which were published by the Cancer Committee of the French Association of Urology (CCAFU) in 2012. The prognosis of patients with intradiverticular bladder tumours has always been perceived to be worse than those with intravesical tumours; however, the only study of 5-year survival rates for patients with IDBT suggests that prognosis might be comparable for these conditions.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Tumours of the bladder and bladder diverticulum.

Similar content being viewed by others

References

  1. Kong, M. X. et al. Histopathologic and clinical features of vesical diverticula. Urology 82, 142–147 (2013).

    Article  Google Scholar 

  2. Tamas, E. F. et al. Histopathologic features and clinical outcomes in 71 cases of bladder diverticula. Arch. Pathol. Lab. Med. 133, 791–796 (2009).

    PubMed  Google Scholar 

  3. Wein, A. J., Kavoussi, L. R., Novick, A. C., Partin, A. W. & Peters, C. A. Campbell-Walsh Urology 10th edn (Elsevier Health Sciences, 2011).

    Google Scholar 

  4. Melekos, M. D., Asbach, H. W. & Barbalias, G. A. Vesical diverticula: aetiology, diagnosis, tumorigenesis, and treatment. Analysis of 74 cases. Urology 30, 453–457 (1987).

    Article  CAS  Google Scholar 

  5. Whitefield, B. Urinary bladder diverticulum and its association with malignancy: an anatomical study on cadavers. Rom. J. Morphol. Embryol. 51, 543–545 (2010).

    Google Scholar 

  6. Idrees, M. T., Alexander, R. E., Kum, J. B. & Cheng, L. The spectrum of histopathologic findings in vesical diverticulum: implications for pathogenesis and staging. Hum. Pathol. 44, 1223–1232 (2013).

    Article  Google Scholar 

  7. Viana, R. et al. The development of the bladder trigone, the centre of the anti-reflux mechanism. Development 134, 3763–3769 (2007).

    Article  CAS  Google Scholar 

  8. Yucel, S. & Baskin, L. S. An anatomical description of the male and female urethral sphincter complex. J. Urol. 171, 1890–1897 (2004).

    Article  Google Scholar 

  9. Stage, K. H. K. & Tank, E. S. E. Primary congenital bladder diverticula in boys. Urology 40, 536–538 (1992).

    Article  CAS  Google Scholar 

  10. Sarihan, H. H. & Abes, M. M. Congenital bladder diverticula in infants. Eur. Urol. 33, 101–103 (1998).

    Article  CAS  Google Scholar 

  11. Evangelidis, A. et al. Surgical management of primary bladder diverticula in children. J. Paediatr. Surg. 40, 701–703 (2005).

    Article  Google Scholar 

  12. Hutch, J. A. J. Saccule formation at the ureterovesical junction in smooth walled bladders. J. Urol. 86, 390–399 (1961).

    Article  CAS  Google Scholar 

  13. Golijanin, D., Yossepowitch, O., Beck, S. D., Sogani, P. & Dalbagni, G. Carcinoma in a bladder diverticulum: presentation and treatment outcome. J. Urol. 170, 1761–1764 (2003).

    Article  Google Scholar 

  14. Baniel, J. & Vishna, T. Primary transitional cell carcinoma in vesical diverticula. Urology 50, 697–699 (1997).

    Article  CAS  Google Scholar 

  15. Childs, M. A. et al. Pathogenesis of bladder calculi in the presence of urinary stasis. J. Urol. 189, 1347–1351 (2013).

    Article  Google Scholar 

  16. Vecchioli Scaldazza, C. Incidence of urothelial carcinoma of the bladder in males with chronic urinary retention. Arch. Esp. Urol. 45, 523–525 (1992).

    CAS  PubMed  Google Scholar 

  17. Burger, M. et al. Epidemiology and risk factors of urothelial bladder cancer. Eur. Urol. 63, 234–241 (2013).

    Article  Google Scholar 

  18. Das, S. S. & Amar, A. D. A. Vesical diverticulum associated with bladder carcinoma: therapeutic implications. J. Urol. 136, 1013–1014 (1986).

    Article  CAS  Google Scholar 

  19. Mic´ic´, S. & Ilic´, V. Incidence of neoplasm in vesical diverticula. J. Urol. 129, 734–735 (1983).

    Article  Google Scholar 

  20. Neuzillet, Y. et al. Intradiverticular bladder tumours: review of the Cancer Committee of the French Association of Urology. Prog. Urol. 22, 495–502 (2012).

    Article  CAS  Google Scholar 

  21. Babjuk, M. et al. EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder: update Eur. Urol. 64, 639–653 (2013).

    Article  Google Scholar 

  22. Stenzl, A. et al. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur. Urol. 59, 1009–1018 (2011).

    Article  CAS  Google Scholar 

  23. Lokeshwar, V. B. et al. Bladder tumour markers beyond cytology: International Consensus Panel on bladder tumour markers. Urology 66, 35–63 (2005).

    Article  Google Scholar 

  24. Raitanen M.-P. et al. Differences between local and review urinary cytology in diagnosis of bladder cancer. An interobserver multicentre analysis. Eur. Urol. 41, 284–289 (2002).

    Article  Google Scholar 

  25. Haecker, A., Riedasch, G., Langbein, S., Alken, P. & Michel, M. S. Diverticular carcinoma of the urinary bladder: diagnosis and treatment problems. A case report. Med. Princ. Pract. 14, 121–124 (2005).

    Article  Google Scholar 

  26. Knappenberger, S. T., Uson, A. C. & Melicow, M. M. Primary neoplasms occurring in vesical diverticula: a report of 18 cases. J. Urol. 83, 153–159 (1960).

    Article  CAS  Google Scholar 

  27. Fekak, H. et al. Intradiverticular bladder tumours. Three case reports. Ann. Urol. (Paris) 36, 53–57 (2002).

    Article  CAS  Google Scholar 

  28. Durfee, S. M., Schwartz, L. H., Panicek, D. M. & Russo, P. MR imaging of carcinoma within urinary bladder diverticulum. Clin. Imag. 21, 290–292 (1997).

    Article  CAS  Google Scholar 

  29. Dondalski, M., White, E. M., Ghahremani, G. G. & Patel, S. K. Carcinoma arising in urinary bladder diverticula: imaging findings in six patients. AJR Am. J. Roentgenol. 161, 817–820 (1993).

    Article  CAS  Google Scholar 

  30. Croitoru, S., Moskovitz, B., Nativ, O., Barmeir, E. & Hiller, N. Diagnostic potential of virtual pneumoendoscopy of the urinary tract. Abdom. Imag. 33, 717–723 (2008).

    Article  Google Scholar 

  31. Khan, M. S., Thornhill, J. A., Gaffney, E., Loftus, B. & Butler, M. R. Keratinising squamous metaplasia of the bladder: natural history and rationalization of management based on review of 54 years experience. Eur. Urol. 42, 469–474 (2002).

    Article  Google Scholar 

  32. Garzotto, M. G., Tewari, A. & Wajsman, Z. Multimodal therapy for neoplasms arising from a vesical diverticulum. J. Surg. Oncol. 62, 46–48 (1996).

    Article  CAS  Google Scholar 

  33. Montague, D. K. & Boltuch, R. L. Primary neoplasms in vesical diverticula: report of 10 cases. J. Urol. 116, 41–42 (1976).

    Article  CAS  Google Scholar 

  34. Redman, J. F., McGinnis, T. B. & Bissada, N. K. Management of neoplasms in vesical diverticula. Urology 7, 492–494 (1976).

    Article  CAS  Google Scholar 

  35. Raheem, O. A., Besharatian, B. & Hickey, D. P. Surgical management of bladder transitional cell carcinoma in a vesicular diverticulum: case report. Can. Urol. Assoc. J. 5, E60–E64 (2011).

    Article  Google Scholar 

  36. Brausi, M. et al. Variability in the recurrence rate at first follow-up cystoscopy after TUR in stage Ta T1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur. Urol. 41, 523–531 (2002).

    Article  Google Scholar 

  37. Brausi, M. Transurethral resection of bladder cancer: a simple and diffusely-performed technique but with controversial outcomes. Urologia 80, 127–129 (2013).

    Article  Google Scholar 

  38. Mariappan, P., Zachou, A. & Grigor, K. M. Edinburgh Uro-Oncology Group. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur. Urol. 57, 843–849 (2010).

    Article  Google Scholar 

  39. Balbay, M. D. et al. The actual incidence of bladder perforation following transurethral bladder surgery. J. Urol. 174, 2260–2263 (2005).

    Article  Google Scholar 

  40. Herkommer, K., Hofer, C., Gschwend, J. E., Kron, M. & Treiber, U. Gender and body mass index as risk factors for bladder perforation during primary transurethral resection of bladder tumours. J. Urol. 187, 1566–1570 (2012).

    Article  Google Scholar 

  41. Gan, C. et al. Snapshot of transurethral resection of bladder tumours in the United Kingdom Audit (STUKA). BJU Int. 112, 930–935 (2013).

    Article  Google Scholar 

  42. Skolarikos, A. et al. Does the management of bladder perforation during transurethral resection of superficial bladder tumours predispose to extravesical tumour recurrence? J. Urol. 173, 1908–1911 (2005).

    Article  Google Scholar 

  43. Golan, S., Baniel, J., Lask, D., Livne, P. M. & Yossepowitch, O. Transurethral resection of bladder tumour complicated by perforation requiring open surgical repair—clinical characteristics and oncological outcomes. BJU Int. 107, 1065–1068 (2011).

    Article  Google Scholar 

  44. Collado, A., Chéchile, G. E., Salvador, J. & Vicente, J. Early complications of endoscopic treatment for superficial bladder tumours. J. Urol. 164, 1529–1532 (2000).

    Article  CAS  Google Scholar 

  45. Thomas, K. & O'Brien, T. Improving transurethral resection of bladder tumour: the gold standard for diagnosis and treatment of bladder tumours. Eur. Urol. 7, 524–528 (2008).

    Article  Google Scholar 

  46. Traxer, O., Pasqui, F., Gattegno, B. & Pearle, M. S. Technique and complications of transurethral surgery for bladder tumours. BJU Int. 94, 492–496 (2004).

    Article  Google Scholar 

  47. Myer, E. G. & Wagner, J. R. Robotic assisted laparoscopic bladder diverticulectomy. J. Urol. 178, 2406–2410 (2007).

    Article  Google Scholar 

  48. Thüroff, J. W., Roos, F. C., Thomas, C., Kamal, M. M. & Hampel, C. Surgery illustrated-surgical atlas: robot-assisted laparoscopic bladder diverticulectomy. BJU Int. 110, 1820–1836 (2012).

    Article  Google Scholar 

  49. Porpiglia, F. et al. Is laparoscopic bladder diverticulectomy after transurethral resection of the prostate safe and effective? Comparison with open surgery. J. Endourol. 18, 73–76 (2004).

    Article  CAS  Google Scholar 

  50. Magera, J. S. Jr, Adam Childs, M. & Frank, I. Robot-assisted laparoscopic transvesical diverticulectomy and simple prostatectomy. J. Robotic Surg. Springer-Verlag 2, 205–208 (2008).

    Article  Google Scholar 

  51. Eyraud, R. et al. Robot-assisted laparoscopic bladder diverticulectomy. Curr. Urol. Rep. 14, 46–51 (2013).

    Article  CAS  Google Scholar 

  52. Sullivan, J. W., Grabstald, H. & Whitmore, W. F. Complications of ureteroileal conduit with radical cystectomy: review of 336 cases. J. Urol. 124, 797–801 (1980).

    Article  CAS  Google Scholar 

  53. Thomas, D. M. & Riddle, P. R. Morbidity and mortality in 100 consecutive radical cystectomies. Br. J. Urol. 54, 716–719 (1982).

    Article  CAS  Google Scholar 

  54. Skinner, D. G., Crawford, E. D. & Kaufman, J. J. Complications of radical cystectomy for carcinoma of the bladder. J. Urol. 123, 640–643 (1980).

    Article  CAS  Google Scholar 

  55. Johnson, D. E. & Lamy, S. M. Complications of a single stage radical cystectomy and ileal conduit diversion: review of 214 cases. J. Urol. 117, 171–173 (1977).

    Article  CAS  Google Scholar 

  56. Charbit, L., Beurton, D. & Cukier, J. Mortalité et morbidité après cystectomie totale pour cancer. J. Urol. (Paris) 90, 39–46 (1984).

    CAS  Google Scholar 

  57. Boström, P. J., Kössi, J., Laato, M. & Nurmi, M. Risk factors for mortality and morbidity related to radical cystectomy. BJU Int. 103, 191–196 (2009).

    Article  Google Scholar 

  58. Lawrentschuk, N. et al. Prevention and management of complications following radical cystectomy for bladder cancer. Eur. Urol. 57, 983–1001 (2010).

    Article  Google Scholar 

  59. McCabe, J. E., Jibawi, A. & Javle, P. M. Radical cystectomy: defining the threshold for a surgeon to achieve optimum outcomes. Postgrad. Med. J. 83, 556–560 (2007).

    Article  Google Scholar 

  60. Fairey, A. et al. Associations among age, comorbidity and clinical outcomes after radical cystectomy: results from the Alberta Urology Institute radical cystectomy database. J. Urol. 180, 128–134 (2008).

    Article  Google Scholar 

  61. Corica, F. A. et al. Intestinal metaplasia is not a strong risk factor for bladder cancer: study of 53 cases with long-term follow-up. Urology 50, 427–431 (1997).

    Article  CAS  Google Scholar 

  62. Smith, A. K., Hansel, D. E. & Jones, J. S. Role of cystitis cystica et glandularis and intestinal metaplasia in development of bladder carcinoma. Urology 71, 915–918 (2008).

    Article  Google Scholar 

  63. Faysal, M. H. & Freiha, F. S. Primary neoplasm in vesical diverticula. A report of 12 cases. Br. J. Urol. 53, 141–143 (1981).

    Article  CAS  Google Scholar 

  64. Boylan, R. N., Greene, L. F. & Mcdonald, J. R. Epithelial neoplasms arising in diverticula of the urinary bladder. J. Urol. 65, 1041–1049 (1951).

    Article  CAS  Google Scholar 

  65. Kelalis, P. P. & McLean, P. The treatment of diverticulum of the bladder. J. Urol. 98, 349–352 (1967).

    Article  CAS  Google Scholar 

  66. American Cancer Society. Cancer Treatment and Survivorship Facts & Figures 2012–2013 [online], (2013).

  67. Shipley, W. U. et al. Selective bladder preservation by combined modality protocol treatment: long-term outcomes of 190 patients with invasive bladder cancer. Urology 60, 62–67 (2002).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Guy's Hospital, Great Maze Pond, London, SE1 9RT, UK

    Nicholas Faure Walker, Christine Gan, Jonathon Olsburgh & Muhammad Shamim Khan

Authors
  1. Nicholas Faure Walker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christine Gan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathon Olsburgh
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Muhammad Shamim Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors made substantial contributions towards writing, editing, reviewing, and discussing the manuscript with colleagues. N.F.W. researched the literature for this article.

Corresponding author

Correspondence to Muhammad Shamim Khan.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

PowerPoint slides

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Walker, N., Gan, C., Olsburgh, J. et al. Diagnosis and management of intradiverticular bladder tumours. Nat Rev Urol 11, 383–390 (2014). https://doi.org/10.1038/nrurol.2014.131

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nrurol.2014.131

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing