Diagnostic Approach for Bladder Diverticulum

Initial Testing

The American College of Radiology recommends ultrasound of the bladder as the preferred first-line imaging modality due to its non-invasive nature and accessibility, with the ability to detect bladder diverticula 1, 2
Ultrasound can effectively evaluate for bladder diverticula detection without radiation exposure, and is suitable for initial imaging 2

CT Urography (CTU) provides comprehensive evaluation of the urinary tract when more detailed imaging is needed, including unenhanced, nephrographic phase, and excretory phase images, and can identify associated abnormalities such as stones, masses, or infection 1, 3
CT Pelvis with IV contrast can depict anatomic abnormalities such as bladder masses, bladder wall thickening, and large bladder diverticula, and is preferred over non-contrast CT for anatomic evaluation unless evaluating for small urinary calculi 4
MRI of the abdomen and pelvis may be considered when CT is contraindicated or for better soft tissue characterization, providing more functional information than CT, although it is less established and less reliable than CTU for urinary tract imaging 1, 2

Cystoscopy allows for direct visualization of the bladder interior to confirm the presence and characteristics of diverticula, and should be considered in patients with suspected complicated bladder diverticula 1, 5
Voiding Cystourethrography (VCUG) is particularly useful when the diverticulum is at or near a ureteral orifice, and can evaluate for vesicoureteral reflux, which may be associated with bladder diverticula 2, 6

Urinary dysfunction (frequency, urgency, straining to void) may be a symptom of bladder diverticulum 4
The relationship of the diverticulum to ureteral orifices is an important finding to document 2

Relying solely on conventional radiography, which has limited sensitivity for bladder diverticula, is a pitfall to avoid in the diagnostic approach for bladder diverticulum 7