Urethral diverticula (pouch-like enlargements) of the lower urinary tract may occur in the bladder or at any point along the urethra in men and women. Urethral diverticulum surgery and symptoms are both covered by Dr. Eric Rovner below.
What is a Urethral Diverticulum?
Hi Diane,
I have a few questions regarding my condition. I've been diagnosed with urethral diverticula and have been told to have surgery.
I am reluctant to have this but I am afraid that the delay will continue to cause more damage to my body since I have a chronic urinary tract infection. I've seen more doctors than I care to count. I explained that urine was escaping from my vagina (which is how it feels). I've been disputed on this point since you can force the diverticula to release with any pressure inside the vagina but I know the feeling inside similar to my menstruation.
I would like to know if you know of any urinary incontinence centers in the New York area? Do you have any experience with this condition? Also do you have a suggestion as to how to treat this in a non-invasive way? The doctors just say it's rare and that they can operate and if it doesn't work they'll operate again, and if it then causes stress incontinence because of the proximity to the sphincter, they'll operate again.
It seems like the beginning of a whole horrible experience, although it may just be a simple procedure. I plan to see a nutritionist prior to the surgery just to be sure if there is a nutritional approach, but I would also like to see someone who may have experience with this condition. A urogynecologist sounds exactly like what I need but I've had some difficulty finding this type of specialist in the New York, New Jersey area. Thank you for your work and any help you can provide.
Urethral Diverticulum Symptoms and Surgery
I asked my colleague Dr Eric Rovner (215-662-2891), urologist and specialist in women’s health at the Penn Center for Continence and Pelvic Health, Division of Urology, University of Pennsylvania, Philadelphia, PA, (left) to define a urethral diverticula (below.) --DKN
Diverticula (pouch-like enlargements) of the lower urinary tract may occur in the bladder or at any point along the urethra in men and women. Acquired bladder diverticula occur more commonly in men whereas urethral diverticula are more commonly diagnosed in adult women.
The origin of acquired urethral diverticula has been attributed to obstruction and subsequent rupture of the periurethral glands into the urethral lumen (cavity) with epithelialization (re-growth of tissue) over the opening of the resulting periurethral cavity (1).
Re-infection and recurrent obstruction of the neck of the bladder cavity causes various symptoms as well as enlargement of the diverticulum. Infection with gonococcal organisms or normal vaginal flora have been suggested as the etiologic (causative) agents. The periurethral glands (glands in the lining of the urethra) exist over the entire length of the urethra, with the majority draining into the distal (end) third of the urethra. Skene's glands are the largest, and most distal of these glands. Urethral diverticula occur mostly in the area of these glands so they are found most commonly in the distal end of the urethra. In many cases, a person may have more than one diverticula.
Urethral diverticula present some of the more challenging diagnostic and reconstructive cases in urology. Patients may complain of the following symptoms: recurrent urinary tract infections, pelvic pain, urinary incontinence, post-void dribbling, dyspareunia (painful sexual intercourse), dysuria (difficulty voiding), urinary frequency and urgency, nocturia, a feeling of incomplete bladder emptying (urinary retention) or a multitude of other non-specific lower urinary tract symptoms.(2)
An anterior vaginal wall mass may be noted on physical examination, which, upon palpation, may be quite tender and express purulent (pus) discharge through the urethra. Nonetheless, adjunctive radiographic studies such as voiding cystourethrography (or double balloon urethrography) should be used to confirm the diagnosis. Advanced diagnostic techniques including ultrasound (3) and MRI (4) may be utilized in some instances to evaluate the size of the diverticulum in relation to the urethral lumen. A diagnosis of urethral hypermobility and/or stress urinary incontinence in the context of a urethral diverticulum may warrant a combined surgical procedure. A surgeon would perform a suspension of the bladder first to avoid potential contamination of retropubic (behind the pubic bone) space during later manipulation of the possibly infected diverticulum (5).
Surgical options include transurethral incision of the diverticular neck, marsupialization (creation of a permanent opening) of the diverticular sac into the vagina [often referred to as a Spence procedure] (6), and surgical excision (removal.) Surgical excision of a urethral diverticulum should be performed with caution. The diverticular sac may be quite adherent to the adjacent urethral lumen and careless excision of the sac may result in a large urethral defect requiring construction of a neourethra (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 the vagina). One complication of the surgery may be stress urinary incontinence.
Note: Dr. Andy Fantl is a good urogynecologist on Long Island, New York. -- DKN
References
1. Ganabathi, K, Leach, G.E, Zimmern, P.E., and Dmochowski,R: (1994) Experience with the management of urethral diverticulum in 63 women, J Urol 152(5 Pt 1):1445-52.
2. Robertson, J: (1996), Urethral diverticula, In Urogynecology & Urodynamics, Edited by Ostergard, D & Bent, A., Baltimore, Williams & Wilkins:361-370.
3. Chancellor M.B, Liu,J.B., Rivas, D.A., Karasick, S., Bagley, D.H. And Goldberg, B.B.L1995) Intraoperative Endo-Luminal Ultrasound Evaluation Of Urethral Diverticula, J Urol;153(1):72-5.
4. Kim B, Hricak H, and Tanagho EA, (1993) Diagnosis of urethral diverticula in women: value of MR imaging. AJR Am J Roentgenol 161: 809-815.
5. Young, G.P.H., Wahle, G.R., Raz, S: (1996) Female urethral diverticulum, In Female Urology, Edited by Raz, S., Philadelphia, W.B. Saunders:477-489.
6. Spence, H.M., Duckett, J.W.: (1970) Diverticulum of the female urethra: Clinical aspects and presentation of a simple operative technique for cure. J. Urol. 104:432-437.
Posted August 2006
Updated July 2009
