Female urethral diverticula: from pathogenesis to management. An update

Abstract

Urethral diverticulum, a sac-like protrusion communicating with the urethral lumen, is a relatively uncommon occurrence. It represents either an infected paraurethral gland that has ruptured in the urethra or a prolapse of the urethral wall through a defect in the periurethral fascia. The classic clinical presentation is a soft, slightly tender vaginal lesion causing dysuria, dyspareunia and dribbling incontinence. Unfortunately, this classic presentation is only seldom seen. The condition may be either asymptomatic or manifest nonspecific symptoms of any lower genitourinary tract pathology. In the majority of cases, diagnosis relies on imaging, with MRI becoming the technique of choice, as it is accurate and provides detailed anatomical information. Complete excision of the diverticular sac with meticulous urethral and periurethral reconstruction is the 'gold standard' treatment. Success rates of 70-100% have been reported, with a few complications occurring, particularly in cases of large and complex diverticula.

Urethral diverticular with broadly squamous metaplasia in a patient with urethral diverticular calculi

“…Excision of UD only was performed in the present case because of the increased risks and higher recurrence rates associated with complete vaginal excision. [4,12] Long-term follow-up for diverticular recurrence and carcinoma metastasis by physical examination and imaging is required in the present case despite the success of conservative surgery with few complications because of the intraoperative identification of a UD calculus and subsequent demonstration of a UD carcinoma by pathological examination. Subsequently, UD calculi may be considered a risk factor for squamous metaplasia, which with high potential of squamous carcinoma in the female urethra, and UD calculi may be considered an indication that surgery is necessary.…”

“…[2] The primary approach to treating UD is surgical resection. Even though several surgical techniques have been described with transvaginal diverticulectomy [3,4] ; however, some common complications, such as the coexisting stone and accompanying carcinoma, may occur without drawing enough attention, making it challenging to study them prospectively. Herein, we report a case of UD with broadly squamous metaplasia (which with the potential of squamous carcinoma) in a patient with UD calculi.…”

A Case of Urethral Diverticulum with Surgical Repair Using Cadaveric Pericardial Tissue

“…Given the rare occurrence of urethral diverticula, there is often a delay in detection leading to persistent symptoms, such as postvoid dribble, dyspareunia, or vaginal discharge, especially if the patient had prior pelvic surgery. [ 16 ]. A delay in diagnosis occurred with our patient as well.…”

Female urethral diverticula: An elusive pathology that can cause significant problems

“…3,11,12 The incidence is increasing as the condition is becoming better known, with improving investigations for diagnosis. 2,10 remnants of Gartner's ducts, or due to the mal-union of primordial folds. 1,13 It is widely accepted that the majority of diverticula are acquired, and are most likely to develop due to repeated infection and/or obstruction of the urethral and peri-urethral glands (also known as Skene's glands).…”

“…1,13 It is widely accepted that the majority of diverticula are acquired, and are most likely to develop due to repeated infection and/or obstruction of the urethral and peri-urethral glands (also known as Skene's glands). [1][2][3]10,13 The majority of these glands are situated within the distal two-thirds of the female urethral submucosa, and secrete mucin. 1,2,10,14 Mucin acts as a sealant in the urethra to protect against urine and aid in continence.…”