Female urethral diverticulum: symptoms, causes and treatment

A urethral diverticulum indicates a protrusion of the urethra or urethra into the tissue surrounding the urethra. There are two types of urethral diverticula, namely congenital and acquired. In childhood, a urethral diverticulum is usually congenital, but rarely an acquired urethral diverticulum may occur in childhood, especially after traumatic catheterization with injury to the urethra or urethra.

  • Urethral diverticulum in women
  • Prevent
  • Causes
  • Acquired urethral diverticulum
  • Congenital urethral diverticulum
  • Symptoms of a urethral diverticulum
  • Examination and diagnosis
  • Diagnostic research
  • Differential diagnosis
  • Treatment of a urethral diverticulum
  • Complications
  • Prognosis

 

Urethral diverticulum in women

A urethral diverticulum indicates a protrusion of the urethra into the tissue surrounding the urethra. If this occurs in a woman, a lump is sometimes visible or palpable at the front of the vagina.

Prevent

A urethral diverticulum is much more common in women than in men and it is estimated that 1-6% of women have suffered from it at some point. It usually affects women between the ages of 30-50, but all age groups can get it.

Causes

Acquired urethral diverticulum

A urethral diverticulum usually results from inflammation of the paraurethral glands or Skene’s glands. These are glands in women around the exit of the urethra. If the glands around the urethra are blocked, increased pressure occurs within the urethra. This blockage causes secretions to accumulate, which can result in an increase in pressure in the urethra, which can cause diverticula.
A urethral diverticulum can sometimes be caused by other causes:

  • injury/trauma
  • obstruction of the urethra by a stone
  • urethral stricture
  • urethral cancer

The size of the diverticulum varies from a few millimeters to several centimeters.

Congenital urethral diverticulum

A disturbance in the development of the urethra can also be the cause. Spontaneous remissions have been rarely reported in congenital diverticula.

Symptoms of a urethral diverticulum

A urethral diverticulum is often asymptomatic, which means that you have no complaints. Any symptoms present are usually non-specific, and may include:

  • a visible and/or palpable lump at the front of the vagina
  • pain when urinating
  • urinary incontinence
  • discharge through the urethra when this lump is emptied
  • recurring bladder infections
  • pain in the urethra
  • pelvic pain

 

Examination and diagnosis

Diagnostic research

The diagnosis of ‘urethral diverticulum’ is made on the basis of:

  • interview with the doctor
  • internal examination of the bladder and urinary tract (urethrocystoscopy)
  • monitoring urine output with an X-ray camera after a contrast fluid has been injected into the bladder (micturition cystography)
  • vaginal examination
  • (possibly) MRI scan: can accurately delineate the size of the diverticulum

 

Differential diagnosis

The following conditions must be excluded:

  • vaginal cyst
  • Skene’s cyst
  • Skene’s duct cyst or abscess
  • ureterocele
  • urethral cancer

 

Treatment of a urethral diverticulum

The treatment of a urethral diverticulum consists of surgically removing the bulge. This procedure is known as ‘diverticulectomy’. The diverticulum is cut away and the opening closed. Marsupialization is also possible. The diverticulum is surgically opened and then sutured in such a way that it remains open and can drain permanently. However, marsupialization is rarely used due to poorer results compared to urethral replication.

Complications

Complications of a urethral diverticulum include:

  • susceptibility to recurrent urinary tract infections
  • infection due to stagnant urine in the diverticulum
  • an increased risk of stone formation
  • Sometimes a diverticulum can evolve into a malignant tumor

 

Prognosis

The prognosis after a diverticulectomy is generally favorable.

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