[Intra-diverticular tumors of the bladder. Natural history and management perspectives]

The review of the literature and our study of 15 tumors in bladder diverticula (IDT) show us that these tumors are rare and mainly observed in elderly adult males. Bleeding is the major symptom. Diagnosis is difficult and treatment is not well defined. Prognosis is good for low stage tumors and catastrophic in the short term for high stage tumors. Nearly half of IDT were primary tumors, and one third of them stay primary until death of the patients. Most of the high stage tumors contained a squamous cell differentiation and all the tumors with these features were deeply invasive. The bad prognosis is mainly related to the difficult and delayed diagnosis, with a long symptomatic period, regardless of treatment. This emphasizes the need for further investigations (biopsies, sonography, computer tomography) when the diagnosis is not evident. The treatment of these tumors depends on the general status of patients and the volume and stage of tumors. Low stage tumors (Ta) and diverticula could be treated either by transurethral resection or by open surgery with good results. In (T1) tumors, only open surgery is recommended to avoid loco-regional relapse. High stage tumors (greater than or equal to P T3) were treated by either TUR or open palliative surgery with the same bad prognosis. No radical treatment was indicated since patients have a bad performance status and most of the tumors extended beyond the diverticulum. Adjuvant treatments were not helpful. While preventive diverticulectomy is to be discussed case by case, we think that an important step in improving the prognosis of these tumors is to make the diagnosis at an earlier stage.