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Urethral Diverticulum
What is
Urethral Diverticulum?
Urethral diverticulum (UD) is a condition in
which a variably sized "pocket" or outpouching
forms next to the urethra. Because it most often
connects to the urethra, this outpouching
repeatedly gets filled with urine during the act
of urination thus causing symptoms.
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Candidates for Urethral Diverticulum
It is
much more common in females then in males and
usually appears between the ages of 40 and 70.
Occurrence in children is extremely rare in the
absence of prior urethral surgery.
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Your Consultation
Currently available techniques for the
evaluation of UD include double-balloon
positive-pressure urethrography (PPU), voiding
cystourethrography (VCUG), ultrasound (US) and
magnetic resonance imaging (MRI) with or without
an endoluminal coil (eMRI). For females, during
physical examination, the anterior vaginal wall
may be carefully felt for masses and tenderness.
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The
Urethral Diverticulum Procedure
Surgical options include transurethral incision
of the diverticular neck, marsupialization
(creation of permanent opening) of the
diverticular sac into the vagina [often referred
to as a Spence procedure], and surgical
excision.
Surgical excision is the treatment of choice but
it should be performed with caution. The
diverticular sac may be quite attached to the
adjacent urethral lumen and careless removal of
the sac may result in a large urethral defect
requiring construction of a new urethra. Other
important considerations during surgery include
identification and closure of the diverticular
neck (connection to the urethral lumen),
complete removal of the mucosal lining of the
diverticular sac to prevent recurrence, and a
multiple layered closure to prevent
postoperative urethrovaginal fistula formation
(formation of an abnormal opening between the
urethra and vagina).
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Recovery
Patients who are treated surgically can expect
to be on antibiotics for 24 hours
postoperatively and discharged home with both
urethral and suprapubic catheters.
Antispasmodics are used liberally to reduce
bladder spasms. A VCUG is obtained at 14 to 21
days postoperatively. If there is no
extravasation, the catheters are removed. If
extravasation is seen, then the urethral
catheter is reinserted and repeat VCUGs are
performed weekly until resolution is noted. In
the vast majority of cases, extravasation will
resolve in several weeks with this type of
conservative management.
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Risks
Common
implications may arise from surgical treatment
and may include recurrent UTIs, urinary
incontinence or recurrent UD. In females,
urethrovaginal fistula is a devastating
complication of urethral diverticulectomy and
deserves special mention.
Some
patients will have persistence or recurrence of
their preoperative symptoms postoperatively. The
finding of a UD following a presumably
successful urethral diverticulectomy may occur
as a result of a new UD, or alternatively, as a
result of recurrence. Recurrence of UD may be
due to incomplete removal of the UD, inadequate
closure of the urethra or residual dead space or
other technical factors. Repeat urethral
diverticulectomy surgery can be challenging, as
anatomic planes may be difficult to identify.
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Frequently Asked Questions
Q:
What causes urethral diverticulum?
A:
The origin of acquired UD has recently been
attributed to repeated infections and/or
obstruction of the
periurethral glands with subsequent
obstruction eventually evolving into UD.
Although some earlier studies have suggested
congenital causes or trauma experienced during
childbirth.
Q:
What are the symptoms of urethral diverticulum?
A:
Although symptoms are highly variable, the most
common symptoms are irritative (i.e., frequency,
urgency and
dysuria) lower urinary tract symptoms (LUTS).
Dyspareunia will be noted by 12 to 24
percent of patients and approximately five to 32
percent of patients will complain of post-void
dribbling. Recurrent
cystitis or urinary tract infection is also
a frequent symptom in one-third of patients.
Other complaints include pain,
hematuria, vaginal discharge, obstructive
symptoms or urinary retention and
incontinence (stress or urge). Up to 20
percent of patients diagnosed with UD may not
have noticeable symptoms. Some patients may also
have a tender anterior vaginal wall mass, which
upon gentle compression may reveal retained
urine or pus discharge through the urethral
opening.
It
is important to note that the size of the UD
does not correlate with symptoms. In some cases,
very large UD may result in minimal symptoms,
and conversely, some UD that are non-palpable
may result in considerable discomfort and
distress. Finally, symptoms may come and go and
may even disappear for long periods of time.
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The following list of Urology procedures are
performed at Beverly Hills Medical Group -
please click the links to find out more:
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