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Objective: To study the histopathology changes and clinical features of vesical diverticula, focusing on the neoplastic entities., Materials and Methods: We retrieved data for 108 patients with vesical diverticula from the archives of our institute during the past 15 years (1998 to 2012) and reviewed their clinical and pathologic characteristics., Results: Diverticula most often involved the lateral wall, followed by the posterolateral and posterior walls of the urinary bladder. Nonneoplastic processes were found in 70 of 108 patients (65%), including inflammation, metaplasia, and urothelial hyperplasia, with or without atypia/dysplasia. Primary carcinomas arising within the diverticula were found in 36 patients (33.3%), of which 33 were urothelial carcinoma, including 5 with divergent differentiation, 2 with squamous carcinoma, and 1 with adenocarcinoma. Patient follow-up for neoplastic diverticula (mean, 59 months; range, 1-108 months) showed that no patients died of disease progression. Concurrent or subsequent urothelial carcinoma was present in the nondiverticular bladder in 19 of 36 patients (53%). Four patients with subsequent extradiverticular urothelial carcinoma showed progression, with pathology upstaging., Conclusion: Inflammation, metaplasia, and dysplasia are commonly seen in vesical diverticula. In our series, which includes patients who underwent endoscopic or surgical intervention and microscopic examination, those with vesical diverticula appeared to have a significantly higher risk for development of urothelial carcinoma, which can occur synchronously or precede carcinoma of the nondiverticular bladder. Compared with their non-diverticulum-associated counterparts, a significantly higher percentage of diverticulum-associated bladder carcinomas are high-grade and invasive. Conservative approaches are suggested for tumors confined within diverticula, after extensive investigation of the nondiverticular bladder., (Copyright © 2013 Elsevier Inc. All rights reserved.)

A 70-year-old man with previous history of TUR-BT presented positive urinary cytology at one year follow-up. Cystoscopy with bladder mapping was negative, and IVP revealed multiple outpouchings of the right upper ureter without hydronephrosis. Ureteroscopy failed because of an underlying stricture. Surgical excision of the strictured segment and of 2.5 cm of cranial ureter was performed. Histopathology demonstrated focal hyperplasia of the urothelium with outpouchings involving only the mucosa, compatible with the diagnosis of pseudodiverticula.

A 71-year-old man presented with a 6-cm scrotal mass and urinary retention. He had had progressive voiding difficulty after an untreated urethral injury in a traffic accident 15 years before presentation. Retrograde urethrography showed an anterior urethral diverticulum with stone formation. He underwent open diverticulectomy and recovered well. Pathologic examination revealed the diverticulum was lined by granulation tissue. Male urethral diverticula are rare and can be congenital or acquired. An acquired urethral diverticulum, as shown in this case, often results from infection, stricture, or trauma. The diagnosis requires a detailed history, physical examination, imaging studies, and pathologic examination.

A 38-year-old woman was found to have a squamous cell carcinoma in a urethral diverticulum after a simple diverticulectomy. The aggressiveness of this histologic subtype of carcinoma, along with this patient's long life expectancy, supported the choice of aggressive therapy. Only nine other cases have been reported. A brief review of the published reports on the presentation, diagnosis, options for treatment, and outcomes is included.

We report a rare case of xanthogranulomatous pyelonephritis occurring in a caliceal diverticulum in a 1-year-old child. She presented with recurrent urinary tract infections. A computed tomography scan demonstrated an enhancing cystic lesion in the left kidney. At open exploration, a caliceal diverticulum was found with a very stenotic opening into the renal pelvis. The diverticulum was enucleated, and the pathologic examination confirmed xanthogranulomatous pyelonephritis in the parenchyma surrounding the diverticulum. The child did well postoperatively with no recurrence of her urinary tract infections.

A seventy-five-year-old man with a four-month history of dysuria had a verrucous squamous carcinoma harbored within a bladder diverticulum. Whereas this low-grade malignancy occasionally develops in bilharzial specimens, its occurrence in schistosome egg-negative bladders is distinctly uncommon, having been the subject of only 1 previous case report.

Three cases of primary adenocarcinoma of the female urethra associated with diverticula are presented. Although the apparent risk of malignant change in urethral diverticula is low, such lesions are usually adenocarcinomas and may arise from urethritis glandularis, mesonephric rests, periurethral glands, or cloacogenic rests.

Carcinoma in situ was found in a urethral diverticulum in a fifty-one-year-old black woman. The discovery of this lesion lends support to the fact that biopsy of the urethral diverticulum should be performed even if a Spence-Duckett procedure is carrier out.

A nephrogenic adenoma located within a urethral diverticulum of a female was found incidental to a diverticulectomy. Cases of this apparently benign lesion have been reported previously, but the lesions were located in the bladder, particularly in older males with a history of chronic cystitis.