Urethral Diverticulum: Symptoms and Treatment Options: Urethral diverticulum (UD) is an uncommon but important urological condition, particularly in women. It refers to a localized outpouching or sac-like protrusion of the urethral wall that communicates with the urethral lumen. Though relatively rare, it can significantly impact quality of life and cause a range of bothersome urinary symptoms. This article provides a comprehensive overview of urethral diverticulum, focusing on symptoms, diagnostic approaches, and the latest treatment options.
What is Urethral Diverticulum?
A urethral diverticulum is essentially a cystic cavity adjacent to the urethra, lined by epithelium and connected to the urethral lumen via a narrow neck. It is more commonly seen in adult women, typically between the ages of 30 and 60, although cases in men and children have also been reported. The prevalence in the female population ranges from 0.6% to 6%, depending on the method of detection.
Causes and Risk Factors
The exact cause of urethral diverticulum is not always clear, but several theories have been proposed:
- Infection and Inflammation: Recurrent urinary tract infections (UTIs) and chronic inflammation may lead to obstruction of periurethral glands, resulting in abscess formation and subsequent diverticulum development.
- Trauma or Surgery: Obstetric trauma, instrumentation, or previous urethral surgeries are considered contributing factors.
- Congenital Causes: Some cases may be congenital in origin due to developmental anomalies in the periurethral glands.
Common Symptoms
Many patients with urethral diverticulum present with vague or nonspecific symptoms, making diagnosis challenging. Some of the most commonly reported symptoms include:
- Post-void dribbling
- Dysuria (painful urination)
- Recurrent UTIs
- Dyspareunia (pain during sexual intercourse)
- Vaginal or periurethral mass
- Incontinence or urgency
One of the hallmark presentations is the “three Ds”: Dysuria, Dyspareunia, and Dribbling.
Diagnosis
Timely and accurate diagnosis of urethral diverticulum requires a high index of suspicion, especially in women with chronic, unexplained urinary symptoms. The diagnostic process includes:
1. Clinical Examination:
A physical pelvic examination may reveal a tender mass along the anterior vaginal wall, which can sometimes express pus or urine.
2. Urinalysis and Urine Culture:
These help identify infections that might co-exist with or result from the diverticulum.
3. Imaging Studies:
- Magnetic Resonance Imaging (MRI): MRI is the gold standard for diagnosing urethral diverticulum. It provides excellent soft tissue contrast and helps delineate the size, location, and complexity of the diverticulum.
- Transvaginal Ultrasound: Useful as an initial imaging modality but may miss smaller or complex diverticula.
- Voiding Cystourethrogram (VCUG): Offers dynamic information about the urinary tract but is less sensitive than MRI.
4. Cystoscopy:
Performed under local or general anesthesia, it helps visualize the urethral lumen and the orifice of the diverticulum.
Differential Diagnosis
Given the vague symptoms, it is important to differentiate urethral diverticulum from other conditions like:
- Skene’s gland cyst
- Gartner’s duct cyst
- Urethral carcinoma
- Bladder neck obstruction
Treatment Options
The choice of treatment depends on the size, symptoms, and complexity of the diverticulum. Not all urethral diverticula require surgery.
1. Conservative Management:
Asymptomatic or very small diverticula may be monitored without surgery, especially in high-risk patients. However, this approach requires regular follow-up.
2. Surgical Management:
Surgery remains the definitive treatment for symptomatic urethral diverticulum.
Transvaginal Urethral Diverticulectomy:
This is the most commonly performed surgery. Key steps include:
- Incising the anterior vaginal wall
- Careful dissection and excision of the diverticulum
- Urethral reconstruction to ensure watertight closure
- Vaginal wall closure
Flap Reconstruction:
In complex or recurrent cases, Martius flap (a pedicled fat pad from the labia majora) is used to reinforce the urethral repair.
3. Postoperative Care:
- A Foley catheter is typically placed for 10-14 days to allow healing.
- Antibiotics and pain management
- Avoidance of sexual activity and strenuous exercise during recovery
Outcomes and Prognosis
The success rate of surgical treatment is high, with most studies reporting symptom relief in 80–90% of patients. However, complications can occur:
- Recurrence of diverticulum
- Urethrovaginal fistula
- Stress urinary incontinence
Recent studies are exploring minimally invasive options and improved surgical techniques to reduce recurrence and complications.
Current Trends and Research
- Robotic-Assisted Surgery: For complex or anterior diverticula, robotic surgery is being evaluated for better precision and outcomes.
- Use of Platelet-Rich Plasma (PRP): PRP is being studied as an adjunct to improve tissue healing post-surgery.
- Long-term Surveillance: There’s growing consensus on the importance of long-term follow-up due to risks of recurrence and malignancy, albeit rare.
References to Recent Studies
- Lee RA, Symmonds RE, Williams TJ. Urethral Diverticulum in Women: A 40-Year Experience. Obstet Gynecol. 2010;116(4):769–774.
- Foster RT, Amundsen CL, Webster GD. Surgical Management of Female Urethral Diverticulum: A Review. Int Urogynecol J. 2007;18(8):921–928.
- Kasyan GR, Tupikina NV, Pushkar DY. Diagnostic Value of MRI in Female Urethral Diverticula. World J Urol. 2020;38(10):2599–2604.
- Myers JB, Harder JL, Clemens JQ. Outcomes of Urethral Diverticulectomy: A Systematic Review. J Urol. 2022;207(2):402–410.
Expert Care at the Institute of Urology, Jaipur
Accurate diagnosis and successful treatment of urethral diverticulum require a combination of experience, clinical acumen, and surgical expertise. At the Institute of Urology, Jaipur, senior urologists Dr. M Roychowdhury and Dr. Rajan Bansal are renowned for their patient-centric approach and advanced surgical skills. Their expertise ensures timely identification and appropriate treatment of even the rarest urological conditions like urethral diverticulum.
The Institute of Urology stands out for providing all urological and general surgery-related services under one roof—including consultation, diagnostics, advanced imaging, minimally invasive surgery, and post-operative care. This integrated approach ensures convenience and comfort for patients, streamlining their treatment journey from start to finish.
Conclusion
Though urethral diverticulum is rare, its impact on a patient’s quality of life can be profound. Timely diagnosis using advanced imaging and expert surgical management can dramatically improve outcomes. With increasing awareness and evolving treatment options, patients now have access to safer, more effective care. For individuals experiencing chronic urinary symptoms, expert evaluation at a specialized center like the Institute of Urology, Jaipur, can make all the difference.
For more information or to book a consultation, visit the Institute of Urology, Jaipur’s official website or connect with our expert team at +91-9829013468
