A urethral diverticulum is a cystic structure (or pouch) that is connected to the urethra. It is thought to arise from inflammation or infection in the glands that are situated just next to the urethra. The prevalence is unknown, however it is reported to occur between 1% and 6% of adult females. Symptoms may include dysuria (burning with urination), dyspareunia (painful intercourse), and dribbling of urine after urination. Other symptoms may include recurrent urinary tract infections, feeling of a vaginal mass or bulge, hematuria (blood in the urine), vaginal discharge, difficulty urinating or slow urinary stream, or urinary incontinence. Some patients may not have any symptoms at all.
Urethral diverticula can be congenital (present at birth) or acquired. Inflammation of the glands adjacent to the urethra which formation of an abscess that eventually invades into the urethra is thought be a common cause. Vaginal birth and trauma have been thought to contribute to the formation of a urethral diverticulum, where the urethral lining (mucosa) herniates through the muscular layers.
A complete evaluation includes a pelvic examination, urinalysis, cystoscopy and imaging. There are many different imaging modalities that may show the urethral diverticulum including a voiding cystourethrogram, ultrasound, and MRI. A urodynamics study may be obtained if the patient's symptoms include urinary incontinence.
The preferred treatment for a urethral diverticulum is surgical excision. These are complex vaginal reconstructive surgeries that should be undertaken by an experienced surgeon. In some cases one may choose not to treat the diverticulum and elect observation.
