Skip to main content

Advertisement

SpringerLink
Log in

Management of Bladder Diverticula in the Pediatric Population

  • Pediatric Bladder Dysfunction (SJ Hodges, Section Editor)
  • Published:
Current Bladder Dysfunction Reports Aims and scope Submit manuscript

Abstract

Bladder diverticula represent protrusion of the urothelial mucosa through the bladder muscular layers and may be either congenital or acquired. Congenital bladder diverticula are usually located adjacent to the ureteral orifices and often are associated with vesicoureteral reflux. Acquired bladder diverticula are usually multiple in nature and are secondary to bladder outlet obstruction or neurogenic bladder. When bladder diverticula are small and do not cause symptoms, non-surgical observation is an acceptable management strategy. The absolute need for surgical intervention of bladder diverticula remains a controversial topic, where current surgical indications for bladder diverticula include diverticula larger than 3 cm, recurrent urinary tract infections, associated severe vesicoureteral reflux, voiding dysfunction, urinary retention, bladder stones, and lower urinary tract symptoms that are persistent after conservative treatment. Open surgical repair has traditionally been the primary treatment choice for bladder diverticula. However, recent advancements in laparoscopic and robotic technology have led to minimally invasive surgical treatment options as alternatives to open surgery with similar success rates, but with reduced morbidity, decreased hospital stay lengths, reduced pain medication requirements, and improved cosmesis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Blane CE, Zerin JM, Bloom DA. Bladder diverticula in children. Radiology. 1994;190:695–7.

    Article  CAS  PubMed  Google Scholar 

  2. Garat JM, Angerri O, Caffaratti J, Moscatiello P, Villavicencio H. Primary congenital bladder diverticula in children. Urology. 2007;70:984–8.

    Article  PubMed  Google Scholar 

  3. Tokunaka S, Koyanagi T, Matsuno T, Gotoh T, Tsuji I. Paraureteral diverticula: clinical experience in 17 cases with associated renal dysmorphism. J Urol. 1980;124:791–6.

    CAS  PubMed  Google Scholar 

  4. Barrett D, Malek R, Kelalis P. Observation on vesical diverticulum in childhood. J Urol. 1976;116:234–6.

    CAS  PubMed  Google Scholar 

  5. Babbitt DP, Dobbs J, Boedecker DA. Multiple bladder diverticula in Williams “Elfin-Facies” syndrome. Pediatr Radiol. 1979;8:29–31.

    Article  CAS  PubMed  Google Scholar 

  6. Daly WJ, Rabinovitch HH. Urologic abnormalities in Menkes’ syndrome. J Urol. 1981;126:262–4.

    CAS  PubMed  Google Scholar 

  7. Levard G, Aigrain Y, Ferkadji L, Elghoneimi A, Pichon J, Boureau M. Urinary bladder diverticula and the Ehler Danlos syndrome in children. J Pediatr Surg. 1989;24:1184–6.

    Article  CAS  PubMed  Google Scholar 

  8. Evangelidis A, Castle EP, Ostlie DJ, Snyder CL, Gatti JM, Murphy JP. Surgical management of primary bladder diverticula in children. J Pediatr Surg. 2005;40:701–3.

    Article  PubMed  Google Scholar 

  9. Oge O, Gemalmaz H, Ozeren B. Acute urinary retention in a child caused by a congenital bladder diverticulum. J Pediatr Surg. 2002;37:926–7.

    Article  PubMed  Google Scholar 

  10. Stein RJ, Matoka DJ, Noh PH, Docimo SG. Spontaneous perforation of congenital bladder diverticulum. Urology. 2005;66:881.

    PubMed  Google Scholar 

  11. Bogdanos J, Paleodimos I, Korakianitis G, Stephanidis A, Androulakakis PA. The large bladder diverticulum in children. J Pediatr Urol. 2005;1:267–72.

    Article  PubMed  Google Scholar 

  12. Kelalis PP. Obstructive uropathy: bladder. In: Kelalis PP, King LR, editors. Clinical Pediatric Urology, Vol 1. 1st ed. Philadelphia, PA: Saunders; 1976. p. 282–91.

    Google Scholar 

  13. Hora M, Eret V, Stránský P, Trávníček I, Dolejšová O, Chudáček Z, et al. Laparoscopic urinary bladder diverticulectomy combined with photoselective vaporisation of the prostate. Wideochir Inne Tech Maloinwazyjne. 2015;10:62–7.

    PubMed  PubMed Central  Google Scholar 

  14. Faramarzi-Roques R, Calvet C, Gateau T, Ballanger PH. Surgical treatment of bladder diverticula: laparoscopic approach. J Endourol. 2004;18:69–72.

    Article  PubMed  Google Scholar 

  15. Jarrett TW, Pardalidis NP, Sweetser P, Badlani GH, Smith AD. Laparoscopic transperitoneal bladder diverticulectomy: surgical technique. J Laparoendosc Surg. 1995;5:105–11.

    Article  CAS  PubMed  Google Scholar 

  16. Nadler RB, Pearle MS, McDougall EM, Clayman RV. Laparoscopic extraperitoneal bladder diverticulectomy: initial experience. Urology. 1995;45:524–7.

    Article  CAS  PubMed  Google Scholar 

  17. Rebouças RB, Monteiro RC, Souza TN, Burity CR, Lisboa JB, Pequeno GB, et al. Laparoscopic bladder diverticulectomy assisted by cystoscopic transillumination. Int Braz J Urol. 2014;40:281–2.

    Article  PubMed  Google Scholar 

  18. Flasko T, Toth G, Benyo M, Farkas A, Berczi C. A new technical approach for extraperitoneal laparoscopic bladder diverticulectomy. J Laparoendosc Adv Surg Tech A. 2007;17:659–61.

    Article  PubMed  Google Scholar 

  19. Figenshau RS, Clayman RV, Kerbl K, McDougall EM, Colberg JW. Laparoscopic nephroureterectomy in the child: initial case report. J Urol. 1994;151:740–1.

    CAS  PubMed  Google Scholar 

  20. Yeung CK, Sihoe JD, Borzi PA. Endoscopic cross-trigonal ureteral reimplantation under carbon dioxide bladder insufflation: a novel technique. J Endourol. 2005;19:295–9.

    Article  CAS  PubMed  Google Scholar 

  21. Liu X, Liu JH, Zhang DY, Hua Y, Lin T, Wei GH, et al. Retrospective study to determine the short-term outcomes of a modified pneumovesical Glenn-Anderson procedure for treating primary obstructing megaureter. J Pediatr Urol. 2015;11:266.e1–6.

    Article  Google Scholar 

  22. Kim SW, Lim NL, Lee YS, Han SW, Im YJ. Laparoscopic intravesical detrusorrhaphy with ureteral plication for megaureter: a novel technique. Urology. 2015;86:187–91.

    Article  PubMed  Google Scholar 

  23. Valla JS, Steyaert H, Griffin SJ, Lauron J, Fragoso AC, Arnaud P, et al. Transvesicoscopic Cohen ureteric reimplantation for vesicoureteral reflux in children: a single-centre 5-year experience. J Pediatr Urol. 2009;5:466–71.

    Article  CAS  PubMed  Google Scholar 

  24. Badawy H, Eid A, Hassouna M, Elkarim AA, Elsalmy S. Pneumovesicoscopic diverticulectomy in children and adolescents: is open surgery still indicated? J Ped Urol. 2008;4:146–9.

    Article  Google Scholar 

  25. Marte A, Cavaiuolo S, Esposito M, Pintozzi L. Vesicoscopic treatment of symptomatic congenital bladder diverticula in children: a 7-year experience. Eur J Pediatr Surg. 2015 May 19. One of the larger experience with vesicoscopic surgery

  26. Myer EG, Wagner JR. Robotic assisted laparoscopic bladder diverticulectomy. J Urol. 2007;178:2406–10.

    Article  PubMed  Google Scholar 

  27. Macejko AM, Viprakasit DP, Nadler RB. Cystoscope and robot-assisted bladder diverticulectomy. J Endourol. 2008;22:2389–91.

    Article  PubMed  Google Scholar 

  28. Tareen BU, Mufarrij PW, Godoy G, Stifelman MD. Robot-assisted laparoscopic partial cystectomy and diverticulectomy: initial experience of four cases. J Endourol. 2008;22:1497–500.

    Article  PubMed  Google Scholar 

  29. Kural AR, Atug F, Akpinar H, Tufek I. Robot-assisted laparoscopic bladder diverticulectomy combined with photoselective vaporization of prostate: a case report and review of literature. J Endourol. 2009;23:1281–5.

    Article  PubMed  Google Scholar 

  30. Meeks JJ, Hagerty JA, Lindgren BW. Pediatric robotic assisted laparoscopic bladder diverticulectomy. Urology. 2009;73:299–301.

    Article  PubMed  Google Scholar 

  31. Altunrende F, Autorino R, Patel NS, White MA, Khanna R, Laydner H, et al. Robotic bladder diverticulectomy: technique and surgical outcomes. Int J Urol. 2011;18:265–71.

    Article  PubMed  Google Scholar 

  32. Christman MS, Casale P. Robot-assisted bladder diverticulectomy in the pediatric population. J Endourol. 2012;26:1296–300.

    Article  PubMed  Google Scholar 

  33. Moore CR, Shirodkar SP, Avallone MA, Castle SM, Gorin MA, Gorbatiy V, et al. Intravesical methylene blue facilitates precise identification of the diverticular neck during robot-assisted laparoscopic bladder diverticulectomy. J Laparoendosc Adv Surg Tech A. 2012;22:492–5.

    Article  PubMed  Google Scholar 

  34. Thiel DD, Young PR, Wehle MJ, Broderick GA, Petrou SP, Igel TC. Robotic-assisted bladder diverticulectomy: tips and tricks. Urology. 2011;77:1238–42.

    Article  PubMed  Google Scholar 

  35. Rao R, Panda S, Hemal AK. Surgical techniques. Robotic bladder diverticulectomy with the da Vinci-S surgical system. J Robot Surg. 2007;1:217–20.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Magera JS, Franck I. Robot-assisted laparoscopic transvesical diverticulectomy and simple prostatectomy. J Robot Surg. 2008;2:205–8.

    Article  Google Scholar 

  37. Mmeje CME, Parra R. Robotic-assisted laparoscopic bladder diverticulectomy and concomitant ureteral re-implantation: initial clinical experience. J Robot Surg. 2008;2:265–7.

    Article  Google Scholar 

  38. Moreno Sierra J, Galante-Romo I, Ortiz-Oshiro E, Castillon-Vela IT, Fernandez-Perez C, Silmi-Moyano A. Bladder diverticulum robotic surgery: systematic review of case reports. Urol Int. 2010;85:381–5.

    Article  PubMed  Google Scholar 

  39. Ganesamoni R, Ganpule AP, Desai MR. Robot-assisted laparoscopic bladder diverticulectomy in a seven-year-old child: case report and points of technique. Indian J Urol. 2012;28:434–6.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Silay MS, Koh CJ. Management of the bladder and calyceal diverticulum: options in the age of minimally invasive surgery. Urol Clin North Am. 2015;42:77–87. This is a recent review article on the topic.

    Article  PubMed  Google Scholar 

  41. Silay MS, Baek M, Koh CJ. Robot-assisted laparoscopic extravesical ureteral reimplantation in children: top-down suturing technique without stent placement. J Endourol. 2015;29:864–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Sungkyunkwan University, School of Medicine, Samsung Medical Center, 50, Irwon-Dong, Gangnam-Gu, Seoul, 135-710, Korea

    Minki Baek

  2. Department of Urology, Division of Pediatric Urology, Bezmialem Vakif University, Faculty of Medicine, 34093, Istanbul, Turkey

    Mesrur Selcuk Silay

  3. Division of Pediatric Urology, Texas Children’s Hospital, Baylor College of Medicine, Clinical Care Center, Suite 620, 6701 Fannin Street, Houston, Texas, 77030, USA

    Chester J. Koh

Authors
  1. Minki Baek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mesrur Selcuk Silay
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chester J. Koh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Chester J. Koh.

Ethics declarations

Conflict of Interest

Drs Baek and Silay declare that they have no conflicts of interest.

Dr. Koh states that they are associated with Inuitive Surgical Inc as consultant/course director.

Human and Animal Rights and Informed Consent

This article does not contain studies with human or animal subjects performed by the author.

Additional information

This article is part of the Topical Collection on Pediatric Bladder Dysfunction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Baek, M., Silay, M.S. & Koh, C.J. Management of Bladder Diverticula in the Pediatric Population. Curr Bladder Dysfunct Rep 11, 205–210 (2016). https://doi.org/10.1007/s11884-016-0378-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11884-016-0378-z

Keywords

Search

Navigation