A urethral diverticulum is an abnormal pouch in the floor of the urethra that may lead to infections, urinary incontinence or discomfort during intercourse. Urethral diverticula are a relatively common finding among women with chronic genitourinary conditions, such as recurrent infections, post void dribbling, and dyspareunia (difficulty or painful intercourse).
About 10% of them may have a small stone in them, and rarely a cancer may develop within the diverticulum. Most cases in women are secondary to urethral infections or obstetric urethral injury.
Diagnosis
This can be usually made by feeling and/or seeing a rounded cystic mass in the anterior vaginal wall which on compression may allow some discharge of urine and/or pus from the urethral opening. Cystoscopy or the post-void film on an Intravenous Pyelogram are likely to demonstrate the diverticulum. Sometimes, urethrography, which is performed by instilling x-ray dye down the urethra, can highlight a diverticulum.
Treatment
Small, asymptomatic diverticula found on routine x-rays may not require surgical removal.
Surgical correction (Urethral Diverticulectomy) is through a transvaginal flap technique for excision of the diverticulum, closing the urethral defect, and then closing the remainder of the defect with overlapping layers. A lightly packed vaginal tampon can be left for 24 hours. The Urinary (Foley) catheter can be left indwelling for 14 days or so prior to considering a voiding trial. Antibiotics and bladder antispasmodics are administered and intercourse discouraged for 6 weeks to allow healing.
Complications of this surgery (urethral diverticulectomy) may include stress urinary incontinence, urethrovaginal fistulae, recurrent diverticula or urinary tract infections.