Urethral diverticulum (UD) is a pocket or pouch that forms along the urethra. Because of its location, it can be filled with urine and lead to infections. A urethral diverticulum can cause:
It is rare but more common in women between age 40 and 70. Children are not usually affected unless they've had urethral surgery.
With better imaging, more Urethral diverticulum has been found and treated. Still, many cases are missed or misdiagnosed.
What causes Urethral diverticulum?
The cause of a Urethral diverticulum is not clear. It is often linked to repeat infections causing weakness in the urethra wall. A block in the glands near the urethra may also cause it. Or, earlier studies point to a birth defect or trauma during childbirth.
What are the symptoms of Urethral diverticulum?
Up to 20% of patients with Urethral diverticulum may not have clear signs. Symptoms are different for everyone, but the most common are:
- Bladder or UTIs that return
- Pelvic pain
- Lower urinary tract symptoms (similar to an overactive bladder)
- Nocturia (feeling the need to urinate several times at night)
- Pain with sex
- Blood in the urine
- Vaginal discharge
- Urinary blockage
- Trouble emptying the bladder
- Accidental loss of urine (incontinence)
Some women have a tender area or mass at the front vaginal wall. With a gentle press, urine or pus may show through the urethral opening.
It is important to note that the size of the Urethral diverticulum doesn’t matter. In some cases, a very large UD may cause only minor symptoms. Or a small Urethral diverticulum may still cause pain. Symptoms can also go away and come back.
How is Urethral diverticulum diagnosed?
Because UDs do not have clear signs, they can be found during an exam or imaging test. In some people, it can be years before the correct diagnosis is made. Patients are often misdiagnosed and treated for other things first.
A proper diagnosis can be made with:
How is Urethral diverticulum treated?
Surgery is the main way to treat UD. Still, not all cases call for surgery. Some patients may not want it, or be able to have a surgery.
Not much is known about untreated Urethral Diverticulum. It is not known if the pockets will become larger or if symptoms will get worse. Some people prefer to wait until symptoms get worse before doing anything. In rare cases, there have been reports of cancers growth in the body with Urethral Diverticulum.
If the patient prefers not to have surgery, counseling and follow-up visits with the doctor is important.
Excision of Urethral Diverticulum
Surgical excision is the treatment done by choice. It should be performed with care with an experienced urologist. The Urethral diverticulum sac may be attached to the urethral opening. If the sac is not removed carefully, it could damage the urethra. This would lead to a major surgical repair.
Surgical options are:
- Cutting into the sac neck
- Creating a permanent opening of the sac into the vagina
- Removing the sac
Other Key Issues in Excision of Urethral Diverticulum
- The diverticular neck (the connection to the urethral opening) should be closed.
- The lining of the diverticular sac should be fully removed to prevent the Urethral diverticulum from coming back.
- A closure with many layers is needed so a new opening doesn’t form between the urethra and vagina.
- If the patient has stress urinary incontinence (SUI), a procedure to fix the leaking may be done at the same time as fixing the diverticulum.
What can be expected after Excision of Urethral Diverticulum?
If the patient chooses not to have surgery, he should still see his urologist for follow-up care.
If the patient has Excision of Urethral Diverticulum:
- He will have antibiotics for at least 24 hours.
- He will be sent home with a catheter in place for 2-3 weeks.
- He may have bladder spasms, which can be managed with drugs.
Two to 3 weeks after Excision of Urethral Diverticulum, a voiding cystourethrogram (VCUG, an x-ray using dye) will be done.
- If there is no fluid leaking, the catheter will be removed.
- If the fluid is seen, repeat VCUG will be done weekly until leaking ends.
- In most cases, the leaking will end in a few weeks.
Common issues after Excision of Urethral Diverticulum are:
- Accidental loss of urine
- UD that comes back
- Ongoing symptoms
- Urethrovaginal fistula (an abnormal passage between the urethra and vagina, which is a serious problem that needs treatment)