Asian Journal of Case Reports in Surgery

Background: Bladder diverticula are outpouchings of the bladder mucosa through the muscularis propria and are most commonly acquired in elderly men secondary to bladder outlet obstruction. Although often asymptomatic, diverticula may lead to significant complications, including recurrent urinary tract infections, stone formation, and malignancy. Tumors arising within bladder diverticula are uncommon but are associated with an unfavorable prognosis due to the absence of a muscular layer.

Case Presentation: We report the case of a 74-year-old male who presented with long-standing lower urinary tract symptoms, recurrent cystitis, and a sensation of incomplete bladder emptying. Imaging studies revealed multiple bladder diverticula, including a giant left-sided diverticulum measuring over 11 cm in diameter, with a nodular lesion suspicious for malignancy. Diagnostic cystoscopy demonstrated three papillary tumors located exclusively within the left-sided diverticulum, which were unsuitable for transurethral resection. The patient subsequently underwent open bladder diverticulectomy. Histopathological examination revealed high-grade invasive urothelial carcinoma arising within the diverticulum.

Conclusion: Carcinoma developing in bladder diverticula is rare but carries a high risk of early invasion due to the lack of a muscularis propria. This case highlights the importance of thorough evaluation of patients with large or symptomatic diverticula and recurrent urinary tract infections. While transurethral resection may be considered for selected intradiverticular tumors, open surgical management remains a definitive and appropriate option when endoscopic treatment is not feasible.