Diagnosis and management of intradiverticular bladder tumours: A pooled analysis of 498 cases

Submitted: November 15, 2022
Accepted: December 7, 2022
Published: December 28, 2022
Abstract Views: 1581
PDF: 671
Supplementary Material: 77
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Objective: Intradiverticular bladder tumors (IDBT) are uncommon clinical entities. We reviewed the literature for clinical presentation, diagnosis and therapeutic options to establish recommendations for diagnostic and therapeutic management.
Methods: Bibliographic research was performed using PubMed from database inception until October 15, 2022. A pooled analysis was performed of 498 patients with IDBT presented in the literature. The evaluation included patient sex, age, diagnostic methods, symptoms, localization of the tumor, tumor staging, tumor histopathology, treatment, and the presence of recurrence. To express results, descriptive statistics were used appropriately.
Results: The mean age at diagnosis was 64.81 years (range 49 days to 84 years). The ratio between men and women was ≈ 24:1, suggesting a male predominance (85% male, 3.6% female). The most common presenting symptom was gross hematuria (60.88%). Most of the patients had cystoscopy (56.85%) and intravenous or computed tomography urography (52.01%). Regarding tumor staging, most of the patients were diagnosed with pT1 tumors. For the histopathology of IDBT, 87.95% of the specimens were transitional cell carcinomas and in 10.84% there were concomitant CIS. Regarding the treatment, radical cystectomy was chosen in 34.34%, partial cystectomy in 26.66%, diverticulectomy in 15.95% and transurethral resection of bladder tumour (TURBT) in 16.36% of the patients.
Conclusions: Most common diagnostic tool for IDBT seems to be cystoscopy followed by computerized tomography urogram. Due to the absence of muscle layer in the diverticulum and the highgrade histology of most of them at diagnosis, cystectomy is the first therapeutic choice. However, for patients that are not considered appropriate candidates or for those presenting with lowgrade and low volume tumors, TURBT is a good option.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Kelalis, P. P., & McLean, P. (1967). The treatment of diverticulum of the bladder. Journal of Urology, 98(3), 349–352.
Kelalis, P. P., & McLean, P. (1967). The treatment of diverticulum of the bladder. Journal of Urology, 98(3), 349–352.
Walker, N. F., Gan, C., Olsburgh, J., & Khan, M. S. (2014). Diagnosis and management of intradiverticular bladder tumours. Nature Reviews Urology, 11(7), 383–390. DOI: https://doi.org/10.1038/nrurol.2014.131
Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The Prisma statement. Journal of Clinical Epidemiology, 62(10), 1006–1012. DOI: https://doi.org/10.1016/j.jclinepi.2009.06.005
Knappenberger, S. T., Uson, A. C., & Melicow, M. M. (1960). Primary neoplasms occurring in vesical diverticula: A report of 18 cases. Journal of Urology, 83(2), 153–159. https://doi.org/10.1016/s0022-5347(17)65675-1 DOI: https://doi.org/10.1016/S0022-5347(17)65675-1
Baniel, J., & Vishna, T. (1997). Primary transitional cell carcinoma in vesical diverticula. Urology, 50(5), 697–699. DOI: https://doi.org/10.1016/S0090-4295(97)00319-1
Garzotto, M. G., Tewari, A., & Wajsman, Z. (1996). Multimodal therapy for Neoplasms arising from a vesical diverticulum. Journal of Surgical Oncology, 62(1), 46–48. DOI: https://doi.org/10.1002/(SICI)1096-9098(199605)62:1<46::AID-JSO10>3.0.CO;2-R
Montague, D. K., & Boltuch, R. L. (1976). Primary neoplasms in vesical diverticula: Report of 10 cases. Journal of Urology, 116(1), 41–42. DOI: https://doi.org/10.1016/S0022-5347(17)58664-4
Redman, J. F., McGinnis, T. B., & Bissada, N. K. (1976). Management of neoplasms in vesical diverticula. Urology, 7(5), 492–494. DOI: https://doi.org/10.1016/0090-4295(76)90186-2
Raheem, O. A., Besharatian, B., & Hickey, D. P. (2011). Surgical management of bladder transitional cell carcinoma in a vesicular diverticulum: Case report. Canadian Urological Association Journal, 5(4). DOI: https://doi.org/10.5489/cuaj.10094
FAYSAL, M. H., & FREIHA, F. S. (1981). Primary neoplasm in vesical diverticula: A report of 12 cases. British Journal of Urology, 53(2), 141–143. DOI: https://doi.org/10.1111/j.1464-410X.1981.tb03153.x
Kelalis, P. P., & McLean, P. (1967). The treatment of diverticulum of the bladder. Journal of Urology, 98(3), 349–352. DOI: https://doi.org/10.1016/S0022-5347(17)62888-X
Voskuilen, C. S., Seiler, R., Rink, M., Poyet, C., Noon, A. P., Roghmann, F., Necchi, A., Aziz, A., Lavollé, A., Young, M. J., Marks, P., Saba, K., van Rhijn, B. W. G., Fransen van de Putte, E. E., Ablat, J., Black, P. C., Sosnowski, R., Dobruch, J., Kumar, P., … Hendricksen, K. (2020). Urothelial carcinoma in bladder diverticula: A multicenter analysis of characteristics and clinical outcomes. European Urology Focus, 6(6), 1226–1232. DOI: https://doi.org/10.1016/j.euf.2018.12.002
Kong, M. X., Zhao, X., Kheterpal, E., Lee, P., Taneja, S., Lepor, H., Melamed, J., & Deng, F.-M. (2013). Histopathologic and clinical features of vesical diverticula. Urology, 82(1), 142–147. DOI: https://doi.org/10.1016/j.urology.2013.02.015
Bourgi, A., Ayoub, E., & Merhej, S. (2016). Diverticulectomy in the management of intradiverticular bladder tumors: A twelve-year experience at a single institution. Advances in Urology, 2016, 1–4. DOI: https://doi.org/10.1155/2016/2345306
Melekos, M. D., Asbach, H. W., & Barbalias, G. A. (1987). Vesical diverticula: Etiology, diagnosis, Tumorigenesis, and treatment. Urology, 30(5), 453–457. DOI: https://doi.org/10.1016/0090-4295(87)90378-5
Di Paolo, P. L., Vargas, H. A., Karlo, C. A., Lakhman, Y., Zheng, J., Moskowitz, C. S., Al-Ahmadie, H. A., Sala, E., Bochner, B. H., & Hricak, H. (2015). Intradiverticular bladder cancer: CT Imaging Features and their association with clinical outcomes. Clinical Imaging, 39(1), 94–98. DOI: https://doi.org/10.1016/j.clinimag.2014.10.004
GOLIJANIN, D. R. A. G. A. N., YOSSEPOWITCH, O. F. E. R., BECK, S. T. E. P. H. E. N. D., SOGANI, P. R. A. M. O. D., & DALBAGNI, G. U. I. D. O. (2003). Carcinoma in a bladder diverticulum: Presentation and treatment outcome. Journal of Urology, 170(5), 1761–1764. DOI: https://doi.org/10.1097/01.ju.0000091800.15071.52
Zhong, H., George, S., Kauffman, E., Guru, K., Azabdaftari, G., & Xu, B. (2014). Clinicopathologic characterization of intradiverticular carcinoma of urinary bladder - a study of 22 cases from a single cancer center. Diagnostic Pathology, 9(1). DOI: https://doi.org/10.1186/s13000-014-0222-8
Hu, B., Satkunasivam, R., Schuckman, A., Miranda, G., Cai, J., & Daneshmand, S. (2014). Urothelial carcinoma in bladder diverticula: Outcomes after radical cystectomy. World Journal of Urology, 33(10), 1397–1402. DOI: https://doi.org/10.1007/s00345-014-1472-5
Yu, C.-C., Huang, J.-K., Lee, Y.-H., Chen, K.-K., Chen, M.-T., & Chang, L. S. (1993). Intradiverticular tumors of the bladder: Surgical implications - an eleven-Year review. European Urology, 24(2), 190–196. DOI: https://doi.org/10.1159/000474292
Md Noh, M. S., Abdul Aziz, A. F., Mohd Ghani, K. A., Lee Kheng Siang, C., Yunus, R., & Mohd Yusof, M. (2017). Giant intradiverticular bladder tumor. American Journal of Case Reports, 18, 212–216. DOI: https://doi.org/10.12659/AJCR.902101
Kumar Sah, A., Maharjan, B., Adhikari, M. B., Rana, R., Basnet, S., Panta, R., & Aryal, G. (2021). Radical cystectomy for intradiverticular bladder carcinoma: A case report. Journal of Nepal Medical Association, 59(242), 933–935. DOI: https://doi.org/10.31729/jnma.6228
Al-Hajjaj, M. (2021). High-grade intradiverticulum bladder tumor: A case report. International Journal of Surgery Case Reports, 83, 106057. DOI: https://doi.org/10.1016/j.ijscr.2021.106057
Dong, W. X., Ping, Y. X., Liang, W. C., Jian, L. Z., & Lin, Z. J. (2013). Small cell carcinoma of the urinary bladder diverticulum: A case report and review of the literature. Journal of Cancer Research and Therapeutics, 9(1), 151. DOI: https://doi.org/10.4103/0973-1482.110372
Grubišić, I., Leniček, T., Tomas, D., Džombeta, T., Trnski, D., Tomašković, I., & Krušlin, B. (2011). Primary osteosarcoma of bladder diverticulum mimicking intradiverticular calculus: A case report. Diagnostic Pathology, 6(1). DOI: https://doi.org/10.1186/1746-1596-6-37
Thwaini, A., McLeod, A., & Nambirajan, T. (2008). Laparoscopic bladder diverticulectomy. Journal of Laparoendoscopic & Advanced Surgical Techniques, 18(6), 849–851. DOI: https://doi.org/10.1089/lap.2008.0253
Abdulrahman, S.-A., Muhammad, I., Abdulrahman, A., Raslan, K., & Alshehabi, Z. (2022). Urothelial carcinoma arising within a congenital bladder diverticulum in an adult male: A rare case report and literature review. Annals of Medicine and Surgery, 77, 103666. DOI: https://doi.org/10.1016/j.amsu.2022.103666
Sousa Escandón, A., Garcia, R., Argüelles, M., Maceiras, F., & Perez-Valcarcel, J. (2000). Carcinosarcoma in a bladder diverticulum. Urologia Internationalis, 65(3), 169–172. DOI: https://doi.org/10.1159/000064866
Rabin, J. M., Hirschfield, L., & Badlani, G. H. (1991). Type IX ehlers-danlos syndrome:Bladder Diverticula with transitional cell carcinoma. Urology, 38(6), 563–566. DOI: https://doi.org/10.1016/0090-4295(91)80181-6
Shah, B., Rodriguez, R., Krasnokutsky, S., Shah, S. M., & Khan, S. A. (1997). Tumour in a giant bladder diverticulum: A case report and review of literature. International Urology and Nephrology, 29(2), 173–179. DOI: https://doi.org/10.1007/BF02551338
Moussa, M., & Abou Chakra, M. (2018). Urothelial carcinoma arising from a bladder diverticulum containing multiple stones: A case report. Urology Case Reports, 20, 80–82. DOI: https://doi.org/10.1016/j.eucr.2018.07.013
Tonzi, M., Watson, M. J., & Singh, A. (2021). Bladder diverticulectomy using a pre-peritoneal, trans-vesicle approach with the SP platform: A novel approach. Urology Case Reports, 39, 101753. DOI: https://doi.org/10.1016/j.eucr.2021.101753
Tsuboi, I., Maruyama, Y., Sadahira, T., Wada, K., Ando, N., Mitsui, Y., Nishiyama, Y., Arata, R., Araki, M., Nasu, Y., & Ono, N. (2019). Inflammatory myofibroblastic bladder tumor with divergent behavior in a patient with spinal cord injury. IJU Case Reports, 2(4), 212–214. DOI: https://doi.org/10.1002/iju5.12085
Elands, S., Vasdev, N., Tay, A., & Adshead, J. M. (2015). Robot-assisted laparoscopic bladder diverticulectomy and ureteral re-implantation for a diverticulum containing high grade transitional cell carcinoma. Current Urology, 8(2), 104–108 DOI: https://doi.org/10.1159/000365699
Haecker, A., Riedasch, G., Langbein, S., Alken, P., & Michel, M. S. (2005). Diverticular carcinoma of the urinary bladder: Diagnosis and treatment problems. Medical Principles and Practice, 14(2), 121–124. DOI: https://doi.org/10.1159/000083925
Abiad, Y. E., & Bakloul, F. (2015). Squamous cell carcinoma in a giant bladder diveticulum. Pan African Medical Journal, 20. DOI: https://doi.org/10.11604/pamj.2015.20.378.6765
Omeroglu, A., Paner, G. P., Wojcik, E. M., & Siziopikou, K. (2002). A carcinosarcoma/sarcomatoid carcinoma arising in a urinary bladder diverticulum. Archives of Pathology & Laboratory Medicine, 126(7), 853–855. DOI: https://doi.org/10.5858/2002-126-0853-ACSCAI
Durfee, S. M., Schwartz, L. H., Panicek, D. M., & Russo, P. (1997). MR imaging of carcinoma within urinary bladder diverticulum. Clinical Imaging, 21(4), 290–292. DOI: https://doi.org/10.1016/S0899-7071(96)00049-6
Matta, E. J., Kenney, A. J., Barré, G. M., & Vanlangendonck, R. M. (2005). Intradiverticular bladder carcinoma. RadioGraphics, 25(5), 1397–1403. DOI: https://doi.org/10.1148/rg.255045205
Madison, B. B. (1948). Papillary carcinoma of a bladder diverticulum treated by transurethral resection. Journal of Urology, 59(1), 42–43. DOI: https://doi.org/10.1016/S0022-5347(17)69340-6
García Figueiras, R., Sousa Escandón, A., García Figueiras, A., González Rodríguez, A. A., Pazos González, G., Armesto Fernández, M., Lapeña Villarroya, J. A., Pérez Valcárcel, J., & Rey Sanjurjo, J. L. (2000). Unusual retrovesical masses in men. European Radiology, 10(10), 1639–1643. DOI: https://doi.org/10.1007/s003300000441
Lembo, F., Subba, E., Laganà, A. S., Vitale, S. G., Valenti, G., & Magno, C. (2016). Intradiverticular Sarcomatoid Carcinoma of The Bladder: An Overview Starting From A Peculiar Case. Urology Journal, 13(4), 2800-2802.
Dragsted, J., & Nilsson, T. (1985). Urothelial carcinoma in a bladder diverticulum evaluated by transurethral ultrasonography. Scandinavian Journal of Urology and Nephrology, 19(2), 153–154. DOI: https://doi.org/10.3109/00365598509180246
Knezevic, M., Grubisic, I., Soipi, S., Tomas, D., Kruslin, B., & Stimac, G. (2014). C202: A rare case of squamous cell carcinoma in urinary bladder diverticulum successfully treated by bladder - sparing surgery. European Urology Supplements, 13(6). DOI: https://doi.org/10.1016/S1569-9056(14)61572-4
Fu, L.-Y., & Adeniran, A. J. (2015). Adenocarcinoma arising from a bladder diverticulum. Journal of Urology, 194(2), 527–528. DOI: https://doi.org/10.1016/j.juro.2015.05.033
Labanaris, A. P., Zugor, V., Smiszek, R., Nützel, R., & Kühn, R. (2009). Small Cell Carcinoma Encountered in a Urinary Bladder Diverticulum. Urology Journal, 6(1), 54-56.
Ozguven S, et al. Invasive urothelial carcinoma detected in bladder diverticulum with FDG PET/CT: A rare case with negative cystoscopy. Rev Esp Med Nucl Imagen Mol. 2014. DOI: https://doi.org/10.1016/j.remn.2013.11.007
Nanbu, A., Tsukamoto, T., Kumamoto, Y., Aoki, M., Hirose, T., Asakura, K., & Kataura, A. (1988). Squamous cell carcinoma of bladder diverticulum withinitial symptoms produced by metastasis to maxillary sinus. European Urology, 15(3-4), 285–286. DOI: https://doi.org/10.1159/000473453
Siegel, W. H. (1974). Neoplasms in bladder diverticula. Urology, 4(4), 411–413. DOI: https://doi.org/10.1016/0090-4295(74)90009-0
Muellner, S. R. (1946). Cancer in diverticulum of the bladder: A pitfall to the resectionist. Journal of Urology, 56(4), 427–428. DOI: https://doi.org/10.1016/S0022-5347(17)69825-2
Wang, C.-K., & Chueh, S.-C. (2007). case report: laparoscopic partial cystectomy with endo-Gia Stapling device in bladder diverticular carcinoma. Journal of Endourology, 21(7), 772–775. DOI: https://doi.org/10.1089/end.2006.0348
Holck, S., & Jørgensen, L. (1983). Verrucous carcinoma of urinary bladder. Urology, 22(4), 435–437. DOI: https://doi.org/10.1016/0090-4295(83)90433-8
Tudor, J., Cantley, R. L., & Jain, S. (2014). Primary small cell carcinoma arising from a bladder diverticulum. Journal of Urology, 192(1), 236–237. DOI: https://doi.org/10.1016/j.juro.2014.04.044
Evans, A. J., Al-Maghrabi, J., Tsihlias, J., Lajoie, G., Sweet, J. M., & Chapman, W. B. (2002). Primary large cell neuroendocrine carcinoma of the urinary bladder. Archives of Pathology & Laboratory Medicine, 126(10), 1229–1232. DOI: https://doi.org/10.5858/2002-126-1229-PLCNCO
Moinzadeh, A., Latini, J., & Hamawy, K. J. (2003). Clear cell adenocarcinoma of the urinary bladder within a diverticulum. Urology, 62(1), 145. DOI: https://doi.org/10.1016/S0090-4295(03)00242-5
Cramer, S. F., Aikawa, M., & Cebelin, M. (1981). Neurosecretory granules in small cell invasive carcinoma of the urinary bladder. Cancer, 47(4), 724–730. DOI: https://doi.org/10.1002/1097-0142(19810215)47:4<724::AID-CNCR2820470417>3.0.CO;2-2
Pearlman, C. K., & Bobbitt, R. M. (1948). Carcinoma within a diverticulum of the bladder. Journal of Urology, 59(6), 1127–1129. DOI: https://doi.org/10.1016/S0022-5347(17)69488-6
Bjerklund Johansen, T. E. (1988). Primary neoplasms in vesical diverticula. Scandinavian Journal of Urology and Nephrology, 22(4), 347–348 DOI: https://doi.org/10.3109/00365598809180812
Mayer, R. F., & Moore, T. D. (1954). Carcinoma complicating vesical diverticulum. Journal of Urology, 71(3), 307–315. DOI: https://doi.org/10.1016/S0022-5347(17)67792-9
Shigehara, K., Taya, T., & Hisazumi, H. (2008). Primary adenocarcinoma in the bladder diverticulum. Scandinavian Journal of Urology and Nephrology, 42(5), 481–483. DOI: https://doi.org/10.1080/00365590802298918
Agarwal, M., Azzopardi, A., & Mufti, G. R. (1993). Pyrexia of unknown origin in association with bladder diverticulum tumour. Postgraduate Medical Journal, 69(811), 403–405. DOI: https://doi.org/10.1136/pgmj.69.811.403
Mittal, V., Rupala, K. K., Yadav, R., & Suryavanshi, M. (2017). Giant sarcomatoid carcinoma with osseous metaplasia from urinary bladder diverticulum. Indian Journal of Surgical Oncology, 8(3), 436–439. DOI: https://doi.org/10.1007/s13193-017-0653-2
J. H. Targett, “Diverticula of the bladder associated with vesical growths,” Transactions of the Pathological Society of London, vol. 47, article 155, 1896.
Neuzillet, Y., Comperat, E., Rouprêt, M., Larre, S., Roy, C., Quintens, H., Houede, N., Pignot, G., Wallerand, H., Soulie, M., & Pfister, C. (2012). Tumeurs de Vessie intradiverticulaires : Revue du Comité de Cancérologie de l’Association Française d’urologie. Progrès En Urologie, 22(9), 495–502. DOI: https://doi.org/10.1016/j.purol.2012.03.008

How to Cite

Katsimperis, S., Tzelves, L., Bellos, T., Angelopoulos, P., Tsikopoulos, I., Mitsogiannis, I., & Papatsoris, A. (2022). Diagnosis and management of intradiverticular bladder tumours: A pooled analysis of 498 cases. Archivio Italiano Di Urologia E Andrologia, 94(4), 486–491. https://doi.org/10.4081/aiua.2022.4.486