Diagnosis and Management of Female Urethral Diverticulum

Abstract

Female urethral diverticulum is a disorder that affects 1% to 6% of women. Women with diverticula may present with a variety of nonspecific genitourinary complaints, making the diagnosis challenging. Diagnosis is made by physical examination and can be confirmed with cystourethroscopy and/or radiographic imaging. Asymptomatic women can be managed conservatively, whereas treatment for symptomatic women usually involves a diverticulectomy. Potential complications from diverticulectomy include diverticulum recurrence, de novo stress incontinence, urethrovaginal fistula, urethral stricture, and recurrent urinary tract infections. This article reviews the etiology, differential diagnoses, evaluation, and management of female urethral diverticula.

Resection of Urethral Diverticulum in Pregnancy

“…Conservative options include expectant management, antibiotics, aspiration, and incision and drainage. 3 Our case of urethral diverticulectomy represents an alternate option of managing a urethral diverticulum during pregnancy remote from delivery in a woman with significant symptoms who failed conservative options. This is noteworthy, particularly that a limited case series suggests most pregnant women (three fourths) with urethral diverticula managed expectantly end up requiring postpartum surgery.…”

“…She had no prior surgical procedures except for type three female genital cutting, which included removing some or all of the external genitalia and reapproximating the labia minora, leaving a small introitus. 3 She had no medical problems, no allergies to medications, one previous uncomplicated vaginal delivery, and was taking only prenatal vitamins.…”

Patient Characteristics and Perioperative Outcomes of Female Urethral Diverticulectomy: Analysis of a Multi-Institutional Prospective Database

“…Urethral diverticulectomy has also been reported in the literature to cause urethral injury, but this complication was not identified within our database. 18 …”

Preoperative CT Voiding Cystourethrography Using 16-Multidetector CT in Female Urethral Diverticulum

“…A few patients present with the classic triad of symptoms, which consisted of dysuria, postvoid dribbling, and dyspareunia [4], [8]. Therefore, a high index of suspicion is important for the diagnosis of urethral diverticulum.…”

“…Voiding cystourethrography (VCUG), urethrography, ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and cystourethroscopy have been used as a diagnostic modality [8], [9]. No one modality has been established as the gold standard of diagnosis, and none of them has perfect sensitivity to visualize the ostium, which is indispensable in surgical planning [9].…”