Bilateral Ureteral Insertion Into the Bladder Diverticula Caused by Prostatic Enlargement: A Complex Surgical Scenario

Bilateral ureteral insertion into the bladder diverticula is an extremely rare condition, particularly when acquired secondary to longstanding bladder outlet obstruction due to prostatic enlargement. We present a complex surgical management of a 72-year-old male with a history of diabetes mellitus and hypertension, who presented with severe lower urinary tract symptoms, gross hematuria, and clot retention. Imaging revealed marked prostatic enlargement and two large bladder diverticula arising from the right and left lateral bladder walls. During the planned open simple transvesical prostatectomy and bilateral bladder diverticulectomy, both ureters were unexpectedly found to insert into the diverticula. Consequently, the intraoperative plan was modified to include bilateral ureteral reimplantation. This case underscores the diagnostic and surgical challenges in managing bladder outlet obstruction complicated by bilateral ureteral insertion into the bladder diverticula. It highlights the importance of individualized surgical planning in managing such unique urological anomalies.