Surgical management of acquired bladder diverticula in adult men: a scoping review

To provide an overview of surgical management strategies for acquired bladder diverticulum (BD) in men with associated benign prostatic obstruction (BPO).

We conducted a scoping review of studies between January 1, 1975, and September 1, 2025, reporting surgical management of acquired BD in men > 45 years. Studies evaluating BD treatment alone or combined with BPO surgery were included. Evidence was stratified by surgical approach.

Forty-four studies encompassing 458 patients were included of which 344 (75.1%) underwent concomitant BPO surgery, most commonly transurethral resection of the prostate. Transurethral (n = 112), laparoscopic (n = 93), robotic (n = 120), and open (n = 133) approaches demonstrated comparable baseline age, whereas the robotic cohort had the largest prostate volume (68.4 cc) and diverticular size. Concomitant BPO treatment was most frequent in the transurethral (88.4%) and open (85%) groups, and least common in robotic cases (48.3%) where it was more often staged. Open series generally reported greater blood loss and longer catheter duration and hospital stay. Major complications (Clavien-Dindo ≥ 3) were uncommon (2.2%), ranging from 0% (transurethral) to 3.2% (laparoscopic), whereas minor complications occurred in 5%. All approaches demonstrated functional improvement.

Although comparative effectiveness data remain limited, all approaches to bladder diverticulectomy demonstrate substantial functional improvement with low complication rates, with the transurethral approach showing low operative time and morbidity descriptively. However, the available evidence is predominantly low level and highly heterogeneous, so these findings should be interpreted as descriptive.