Urethral Diverticulum

A urethral diverticulum is an unusual defect along the urethra, where a “pocket” or sac forms inside the urethra.

Pelvic organ prolapse occurs in women when pelvic floor muscles don't support the uterus, bladder, ureter, vagina, cervix, small intestines and/or the rectum. When these organs drop out of position, it's called a prolapse.

• Statistically, it is evident that women are more likely to develop this condition compared to men.
• It is most prevalent in adults of ages 40 to 70 and extremely rare in children.

Causes

To date, the exact cause of illness is unknown. However, previous research linked it to vaginal birth or trauma. Lately, the defect is said to be caused by the subsequent blocking of the periurethral glands.

Symptoms

Some patient may not experience any signs. Signs and symptoms are usually different for every particular patient. However, the most common symptoms include:

• Dyspareunia (pain during sex)
• Dribbling after urination
• Dysuria (burning with urination)
• Frequent urinary tract infections
• Hematuria (blood in the urine)
• Vaginal discharge,
• Urinary incontinence

Patients may also experience a tender area or mass at the frontal vaginal wall. With this type of condition, the severity of symptoms do not necessarily point to the size of the diverticulum. In some instances, minor symptoms may indicate a sizeable urethral diverticulum and vice versa.

Treatment

An MRI of the pelvis is done to confirm the diagnosis and help surgeons capture the location and size of the defect. A cystoscope is used to see the inside of the urethra.

Surgery is the primary approach to treating the disorder. There are three main surgical options, which include:

• Transurethral incision of the diverticular neck (cutting into the sac neck)
• Marsupialization (initiating a perpetual opening of the sac into the vagina)
• Surgical excision

In most cases, surgical excision is the preferred method. During surgery, measures should be taken to ensure that the condition does not recur. These measures include closing the diverticular neck, removing the entire lining of the sac, and doing a multilayered closure to prevent postoperative urethrovaginal fistula formation (development of an abnormal opening between the urethra and vagina).