Urethral diverticulum in women
- Lieschen H Quiroz, MD
Lieschen H Quiroz, MD
- Associate Professor
- Female Pelvic Medicine and Reconstructive Surgery
- Oklahoma University Health Sciences
- Robert E Gutman, MD
Robert E Gutman, MD
- Associate Professor of Obstetrics and Gynecology and Urology
- Georgetown University Medical Center
- Associate Fellowship Director
- Female Pelvic Medicine and Reconstructive Surgery
- Washington Hospital Center
- Section Editors
- Linda Brubaker, MD, FACOG
Linda Brubaker, MD, FACOG
- Section Editor — Urogynecology and Pelvic Organ Prolapse
- Health Sciences Clinical Professor
- University of California, San Diego
- Deborah Levine, MD
Deborah Levine, MD
- Section Editor — Imaging
- Professor of Radiology
- Director of Ob/Gyn Ultrasound
- Department of Radiology
- Beth Israel Deaconess Medical Center
A urethral diverticulum is a localized outpouching of the urethral mucosa into the surrounding non-urothelial tissues . This is an uncommon condition that is found mainly in adult women. The possibility of this diagnosis is often overlooked, even in women with presenting symptoms or findings (eg, urinary incontinence, dysuria, dyspareunia, vaginal mass). Delayed or missed diagnosis of this condition can lead to chronic morbidity including urethral calculus formation, chronic or recurrent urinary tract infections (UTIs) or, rarely, malignant transformation .
The epidemiology, diagnosis, evaluation, and treatment of urethral diverticula in women are reviewed here. Diagnosis and management of other etiologies of urinary incontinence or dyspareunia are discussed separately. (See "Evaluation of women with urinary incontinence" and "Approach to the woman with sexual pain".)
The true prevalence of urethral diverticula is difficult to estimate, given the difficulty of accurate and timely diagnosis. The reported prevalence of urethral diverticula in adult females from studies of autopsy specimens or urethrography series ranges from 1 to 5 percent [3,4]. A population-based study estimated the incidence to be less than 20 per 1,000,000 (<0.02 percent) per year . Urethral diverticula have rarely been reported in men or in children [6,7].
Urethral diverticula typically present between the ages of 20 and 60 years [1,4].
Risk factors for a urethral diverticulum include female gender, pelvic trauma, and periurethral procedures, but there are no data to quantify these risks [8-10]. It appears that black women are three-fold more likely than white women to have a urethral diverticulum, based upon data from hospital admissions and surgical procedures related to this diagnosis .
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- ANATOMY AND HISTOPATHOLOGY
- CLINICAL PRESENTATION
- Vaginal mass
- EVALUATION OF WOMEN WITH A SUSPECTED URETHRAL DIVERTICULUM
- Medical history
- Physical examination
- Urine tests
- Imaging studies and endoscopy
- - Magnetic resonance imaging
- - Ultrasound
- - Urethroscopy
- - Tests no longer recommended
- Voiding cystourethrography
- Retrograde positive pressure urethrography
- DIFFERENTIAL DIAGNOSIS
- EVALUATION TO EXCLUDE ASSOCIATED CONDITIONS
- Malignant or benign neoplasms
- Patients without bothersome symptoms
- - Conservative management
- Patients with bothersome symptoms or suspected malignancy or calculi
- - Transvaginal diverticulectomy
- Preoperative preparation
- Complex diverticuli:
- Concomitant incontinence procedures
- Postoperative care
- Outcome and complications
- - Other surgical procedures
- Urethroscopic excision
- Pregnant women
- SUMMARY AND RECOMMENDATIONS