膀胱憩室內的尿路上皮癌：病例系列與文獻回顧

呂晉典¹、鄭元佐²、林琬菱³

高雄長庚紀念醫院泌尿科¹、高雄市立大同醫院泌尿科²、高雄長庚紀念醫院麻醉科³

Urothelial Carcinoma Within a Bladder Diverticulum:
Case Series and Literature Review

Jin-Dien Liu¹, Yuan-Tso Cheng², Wan-Ling Lin³

¹Department of Urology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

²Department of Urology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan.

³ Department of Anesthesiology, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.

Purpose:

Intra-diverticular bladder cancer (IDBC) is rare, accounting for ~1% of bladder cancers. The absence of muscularis propria in diverticula predisposes to early invasion and complicates staging. While radical surgery is standard for high-risk disease, conservative approaches may be suitable for select early-stage cases.

Materials and Methods:

We retrospectively reviewed three male patients (aged 65–82) diagnosed with early-stage IDBC (Ta–T1) between 2017 and 2025 at a Kaohsiung Chang Gung Memorial hospital. All underwent TURBT as initial management. Adjuvant therapies included intravesical mitomycin C, epirubicin or systemic chemotherapy (gemcitabine/cisplatin/nivolumab). Recurrences were treated using 40W Green-Light laser vaporization. Patients were followed for five years.

Results:

Three male patients aged 65 to 82 years were diagnosed with non-muscle invasive intra-diverticular bladder cancer (IDBC), including two cases of Ta and one case of T1 urothelial carcinoma. All tumors were located within bladder diverticula and initially managed with transurethral resection of bladder tumor (TURBT). One patient had high-grade, and two had low-grade papillary urothelial carcinoma. During follow-up, all patients experienced tumor recurrence. Each underwent 40W Green-Light laser vaporization as a bladder-sparing treatment for recurrent lesions. Two patients received intravesical chemotherapy (mitomycin C or epirubicin), and one received systemic chemo-immunotherapy with gemcitabine, cisplatin, and nivolumab. No tumor recurrence was observed during a five-year surveillance period, and all patients maintained good functional status (ECOG 0–1). These cases suggest that selected patients with early-stage IDBC may benefit from bladder-sparing strategies combining TURBT, adjuvant therapy, and Green-Light laser vaporization.

Conclusion:

Intra-diverticular bladder cancer is an uncommon condition with an incidence of approximately 1%. The cases presented in our study suggest that conservative management may be a viable treatment option for selected patients in early-stage IDBC.