A urethral diverticulum is a rare medical condition characterized by the formation of a pouch or sac along the urethra, the tube carrying urine out of the body. This outpouching can collect urine or pus, leading to various issues. While instances have been reported in males, this condition occurs almost exclusively in the female population, typically affecting women between the ages of 30 and 70 years.
Symptoms and Causes
Women experiencing a urethral diverticulum often present with a range of symptoms. These include painful urination (dysuria), post-void dribbling (where urine leaks after voiding), and painful intercourse (dyspareunia) also occurs.
Beyond these specific symptoms, individuals may also experience recurrent urinary tract infections (UTIs), pelvic pressure, and changes in urinary habits such as increased frequency or urgency. Some may also notice blood in their urine or unusual vaginal discharge.
Urethral diverticula are primarily acquired conditions. They often result from repeated infections and inflammation of the periurethral glands, small secretory glands near the urethra. These infections can lead to obstruction and enlargement of the glands, eventually forming a sac that ruptures into the urethral lumen. Trauma from events like childbirth or previous surgical procedures can also contribute to the development of a urethral diverticulum. While most cases are acquired, congenital urethral diverticula, present at birth, are considered very rare.
The Diagnostic Process
Diagnosis begins with a thorough medical history and physical examination. During the physical exam, a healthcare provider may feel a mass or tender area through the anterior vaginal wall, and gentle pressure on this area might cause urine or pus to discharge from the urethral opening.
Imaging studies are generally required for definitive confirmation. Magnetic Resonance Imaging (MRI) is often preferred for its detailed views of soft tissues and accurately defining the extent and location of the diverticulum. Other diagnostic tools that may be used include a transvaginal ultrasound, which can measure the size and location of the lesion, or a voiding cystourethrogram (VCUG), an X-ray study that involves filling the bladder with contrast dye to visualize the urethra during urination.
Treatment Approaches
For symptomatic urethral diverticulum, surgical intervention is considered the standard and most effective treatment. The procedure, a urethral diverticulectomy, involves complete removal of the diverticular sac and careful closure of the opening connecting it to the urethra.
After sac removal, the urethra is meticulously reconstructed, often in multiple layers, to ensure a watertight seal and promote healing. To allow the surgical site to recover, a urinary catheter is typically left in place for 10 to 21 days. This catheter helps divert urine away from the healing area.
After catheter removal, a voiding cystourethrogram may confirm the surgical site has healed without leakage. While surgery is the primary approach for symptomatic cases, “watchful waiting” may be an option for rare, small, asymptomatic diverticula. However, this conservative management is not standard for patients with discomfort or complications.