A bladder diverticulum is a pouch that forms when the bladder lining pushes out through a weak point in the muscle wall. In adults it usually develops because of long-standing blockage at the bladder outlet, most often from an enlarged prostate (BPH) or a urethral stricture, which raises the pressure inside the bladder. Because the pouch has little or no muscle in its wall, it cannot squeeze urine out and tends to hold a stagnant pool after each void.
Bladder diverticulectomy is an operation to remove the pouch and repair the bladder wall. It is performed for benign (non-cancerous) reasons in the great majority of cases, and in suitable patients it can be done robotically through keyhole incisions. Just as important as removing the pouch is treating the underlying obstruction that caused it, either at the same operation or as a planned separate step, otherwise symptoms often persist and a new diverticulum can form.
If a tumour is found within a diverticulum, the operation is planned differently, as a cancer operation that removes the diverticulum together with a margin of surrounding bladder. This is covered on our Partial Cystectomy page.
TREATMENTS
Bladder Diverticulectomy
When Is Diverticulectomy Recommended?
Many diverticula are found incidentally, cause no harm and can simply be monitored. Surgery is considered when the diverticulum itself is causing problems, most commonly:
• Poor emptying and residual urine: a large diverticulum that holds a significant pool of urine after voiding, contributing to a weak stream, double voiding or a feeling of incomplete emptying.
• Recurrent urinary tract infections: stagnant urine inside the pouch is prone to repeated infection that antibiotics alone cannot fix.
• Bladder stones: stones can form in the pooled urine within the diverticulum.
• Abnormal tissue inside the pouch: if cystoscopy or imaging raises suspicion of a tumour within the diverticulum, removal is recommended and is planned as a partial cystectomy (see that page).
A diverticulum almost always has an underlying cause, usually obstruction at the bladder outlet. Part of our assessment is identifying that cause.
How the Operation Is Performed
The aim is to remove the pouch at its neck and close the bladder securely. The approach is tailored to the size and position of the diverticulum:
• Robotic keyhole surgery: for most patients this is our preferred approach, freeing the diverticulum, detaching it at its neck and repairing the bladder with dissolving sutures through small incisions.
• Open surgery: occasionally more appropriate for very large or awkwardly placed diverticula, or where previous surgery makes keyhole access difficult.
• Endoscopic treatment: in selected frail patients the diverticular opening can be widened or treated from inside the bladder without removing the pouch.
• Treating the obstruction: a prostate procedure such as TURP/ HoLEP/ robotic simple prostatectomy, or treatment of a urethral stricture, may be performed at the same operation or as a separate planned procedure.
A catheter is left in place while the bladder repair heals.
Risks and Considerations
All procedures carry risks, which your surgeon will discuss with you in detail. These may include:
• Bleeding, infection (including urinary tract infection) or wound problems.
• Urine leak from the bladder repair.
• Injury to the ureter, bladder or bowel
• Temporary urinary frequency, urgency or bladder spasms while the bladder heals.
• Recurrence of the diverticulum or persisting symptoms, particularly if the underlying obstruction is not adequately treated.
• An unexpected finding of tumour in the removed tissue, which would need further assessment and treatment.
Recovery at a glance: Most patients stay 2-3 nights in hospital and go home with a catheter, which is removed after about 1-2 weeks once an X-ray of the bladder (cystogram) confirms the repair has healed, with a gradual return to normal activities over 2-4 weeks.
1
Assessment and Planning
We confirm the diagnosis with imaging, cystoscopy and bladder function tests, and identify the underlying cause, planning treatment of any bladder outlet obstruction (eg. TURP) at the same operation or as a staged procedure.
2
The Operation
The diverticulum is removed, usually robotically through keyhole incisions, the bladder is repaired with dissolving sutures, and the removed tissue is sent to pathology.
3
Recovery and Catheter Care
You go home with a catheter while the bladder heals, and a cystogram confirms the repair is watertight before the catheter is removed, usually at 1-2 weeks.
4
Follow-Up
We review your pathology result, recheck your urinary flow and bladder emptying, and confirm infections and symptoms have settled, arranging further treatment of the obstruction if it is needed.
Our Approach
