Bladder diverticula management - conservative and surgical outcomes: a narrative review from EAU endourology

Standardized treatment of bladder diverticula is not defined. The majority of evidence comes from single-centre case series and high-quality studies are lacking.

Surgery is the preferred option to treat a symptomatic bladder diverticulum. Robot-assisted surgery has progressively replaced open approach, either with an extravesical or transvesical or transdiverticular technique, with favourable outcomes. Endoscopic treatment may represent a valid alternative mainly in old and frail patients. In case of intradiverticular tumour, some concerns arise on the optimal management between transurethral resection, partial and radical cystectomy. Pathological evaluation may underestimate the oncological status given the lack of muscular layer in the diverticular wall.

Surgical diverticulectomy is considered the reference option for symptomatic diverticula. Robotics should be the preferred approach whenever available. Whatever the technique used (extravesical, transvesical, transdiverticular), good outcomes have been reported. Alternatively, endoscopic incision of diverticular neck and fulguration of the mucosa may be considered for selected patients. The relationship between bladder diverticula and bladder cancer is unclear and the choice between transurethral resection, partial or radical cystectomy should be based on multiple factors, starting from tumour stage and grade. However, evidence comes mainly from limited, heterogeneous case-series. Further studies are needed to properly assess the management of these patients.