Giant Urinary Bladder Diverticula presenting as Epigastric Mass and Dyspepsia

Bladder diverticulum is a result of bladder mucosa and submucosa herniation through the muscularis propria of bladder wall. Bladder diverticula are mostly seen in the elderly men in association with benign prostatic hyperplasia (BPH).

A 74-year-old man presented with complaints of vague epigastric discomfort, dyspepsia, and mild lower urinary tract symptoms. An ultrasonography of the abdomen showed bilateral hydroureteronephrosis, large cystic lesion with the size of 26.3 × 20.5 cm and in continuation of urinary bladder and prostate of 70 mL volume. Voiding cystourethrogram revealed a large diverticulum with its neck communicating with bladder on posterior aspect. Abdominopelvic contrast-enhanced computed tomography revealed bilateral hydronephrosis with large bladder diverticulum of 27.3 × 21.5 cm in size with smooth diverticular wall. On cystoscopy, the neck of diverticulum was seen at the posterior wall of bladder. Open prostatectomy and diverticulectomy were done simultaneously (Figure 3). Postoperative course was uneventful. The histopathological assessment showed features of chronic inflammation without any evidence of malignancy. On the third postoperative day, the urethral catheter was removed and suprapubic catheter was clamped. Patient was voiding well and cystography done on day 12 revealed smooth bladder contour without any leakage; hence, suprapubic catheter was removed. Patient was discharged in satisfactory condition.

The elderly men are at high risk of developing bladder diverticulum, which may be due to high prevalence BPH in this group. Although presentation of bladder diverticulum is nonspecific, its effect on renal system is significant. Therefore, awareness of patients and physicians is necessary to prevent its consequences.