A urethral diverticulum is a condition where a small pouch or pocket forms along the urethra, the tube that carries urine out of the body. This sac can fill with urine, which is the underlying cause of many associated symptoms and potential infections. The condition is most frequently diagnosed in women, though it can occur in men.
Causes and Symptoms
Urethral diverticula are most often acquired during a person’s lifetime rather than being present at birth. A primary cause is thought to be repeated infections of the periurethral glands, which are small glands that surround the urethra. When these glands become blocked, they can fill with fluid, expand, and eventually form a pouch that protrudes into the urethral wall. Trauma experienced during childbirth can also weaken the muscles and tissues around the urethra, creating conditions that may lead to the formation of a diverticulum.
The symptoms of a urethral diverticulum can vary, and up to 20% of individuals with the condition may not experience any noticeable signs. When symptoms do appear, they are often referred to as the “three Ds”: dysuria, which is pain or burning during urination; dyspareunia, or pain during sexual intercourse; and post-void dribbling, which is the leakage of urine after urination is complete.
Beyond these, individuals may experience other urinary issues. Recurrent urinary tract infections (UTIs) are common, as the urine that collects in the pouch can become a breeding ground for bacteria. Other symptoms can include pelvic pain, a frequent or urgent need to urinate, difficulty emptying the bladder completely, and the sensation of a palpable mass in the anterior wall of the vagina. The size of the diverticulum does not always correlate with the severity of the symptoms.
The Diagnostic Process
Confirming a diagnosis of urethral diverticulum begins with a medical history and a physical examination. During the exam, a healthcare provider may feel a tender mass along the front wall of the vagina. Gently pressing on this area might cause a discharge of urine or pus from the urethral opening, which is a strong indicator of the condition.
Imaging studies are used for visualizing the pouch and confirming the diagnosis. Magnetic resonance imaging (MRI) is often the most effective technique because it provides clear, detailed pictures of the soft tissues of the urethra and surrounding structures. This allows for an accurate assessment of the diverticulum’s size and location, which is important for surgical planning.
A voiding cystourethrogram (VCUG) is an X-ray study that involves filling the bladder with a contrast dye and taking images as the patient urinates to show the diverticulum filling. A transvaginal ultrasound can also be used to create images of the urethra. In some cases, a cystoscopy, a procedure where a thin tube with a camera is inserted into the urethra, allows the doctor to directly see the opening of the diverticulum from inside the urethra.
Treatment Approaches
The approach to treating a urethral diverticulum is based on the severity of the symptoms. For individuals who have a diverticulum but experience no discomfort or related problems, a doctor may recommend observation without immediate intervention. In cases with mild symptoms, conservative management might involve antibiotics to treat any active urinary tract infections.
For persistent symptoms, surgical intervention is the most effective treatment. The standard procedure is a urethral diverticulectomy, which involves the complete removal of the pouch. A surgeon dissects the sac away from the urethral wall and then repairs the urethra, eliminating the pocket where urine collects and resolving the associated symptoms.
Before surgery, any active infection in the urinary tract or the diverticulum must be treated with antibiotics to reduce the risk of complications. The surgical removal of the pouch is considered the definitive treatment for providing long-term relief.
Potential Complications and Recovery
If a urethral diverticulum is left untreated, it can lead to several complications. The stagnant urine can contribute to the formation of stones inside the diverticulum, and chronic infections are also a concern. In very rare instances, a type of cancer can develop within the lining of the diverticulum over time.
Following a urethral diverticulectomy, recovery typically involves a short-term hospital stay. A urinary catheter is usually placed to allow the repaired urethra to heal and remains in place for a few weeks. Full recovery generally takes about two to three weeks. As with any surgery, there are potential risks, including recurrence of the diverticulum, development of a urethral stricture (narrowing of the urethra), or formation of a urethrovaginal fistula, an abnormal connection between the urethra and the vagina.