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女性尿道憩室

Authors
Lieschen H Quiroz, MD
Robert E Gutman, MD
Section Editors
Linda Brubaker, MD, FACOG
Deborah Levine, MD
Deputy Editor
Sandy J Falk, MD, FACOG
Translators
刘培淑, 主任医师，教授

引言

尿道憩室是由尿道黏膜局部外翻至周围非尿路组织所形成[1]。此病并不常见，主要发生在成年女性中。即使是在有主诉症状或检查发现(如尿失禁、尿痛、性交痛、阴道包块)的女性中，该病也常被漏诊。该疾病的延迟诊断或漏诊会导致慢性并发症，包括尿道结石形成、慢性或反复性泌尿道感染(urinary tract infections, UTIs)或罕见情况下可发生恶性转化[2]。

女性尿道憩室的流行病学、诊断、评估和治疗将总结在此。尿失禁或性交痛的其他病因的诊断及处理将单独讨论。 (参见“尿失禁女性的评估方法”和“女性性交痛概述”)

流行病学

鉴于准确并及时的诊断较为困难，尿道憩室的实际患病率难以估计。尸检标本研究或尿道造影病例系列研究发现成年女性尿道憩室的患病率为1%-5%[3,4]。一项人群研究估计，尿道憩室的年发病率小于20例/1,000,000人(<0.02%)[5]。此病在男性或儿童中罕见报道[6,7]。

尿道憩室通常发病于20-60岁之间[1,4]。

其危险因素包括：女性、盆腔创伤及尿道周围手术，但没有数据对这些风险进行量化[8-10]。根据与该诊断有关的入院及手术操作的数据，黑人女性尿道憩室发生率似乎是白人女性的3倍[4]。

                                    

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-15.
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References
Top
  1. Foley CL, Greenwell TJ, Gardiner RA. Urethral diverticula in females. BJU Int 2011; 108 Suppl 2:20.
  2. Romanzi LJ, Groutz A, Blaivas JG. Urethral diverticulum in women: diverse presentations resulting in diagnostic delay and mismanagement. J Urol 2000; 164:428.
  3. Mårtensson O, Duchek M. Translabial ultrasonography with pulsed colour-Doppler in the diagnosis of female urethral diverticula. Scand J Urol Nephrol 1994; 28:101.
  4. Burrows LJ, Howden NL, Meyn L, Weber AM. Surgical procedures for urethral diverticula in women in the United States, 1979-1997. Int Urogynecol J Pelvic Floor Dysfunct 2005; 16:158.
  5. El-Nashar SA, Bacon MM, Kim-Fine S, et al. Incidence of female urethral diverticulum: a population-based analysis and literature review. Int Urogynecol J 2014; 25:73.
  6. Kadian YS, Rattan KN, Singh M, Kajal P. Congenital anterior urethral diverticulum in children: a case report and review. ISRN Surg 2011; 2011:120307.
  7. Alphs HH, Meeks JJ, Casey JT, Gonzalez CM. Surgical reconstruction of the male urethral diverticulum. Urology 2010; 76:471.
  8. Athanasopoulos A, McGuire EJ. Urethral diverticulum: a new complication associated with tension-free vaginal tape. Urol Int 2008; 81:480.
  9. Clemens JQ, Bushman W. Urethral diverticulum following transurethral collagen injection. J Urol 2001; 166:626.
  10. Morton HC, Hilton P. Urethral injury associated with minimally invasive mid-urethral sling procedures for the treatment of stress urinary incontinence: a case series and systematic literature search. BJOG 2009; 116:1120.
  11. Stepp KJ, Walters MD. Anatomy of the lower urinary tract, rectum, and pelvic floor. In: Urogynecology and Reconstructive Surgery, 3rd, Walters, MD, Karram, MM. (Eds), Mosby Elsevier, Philadelphia 2007. p.17.
  12. Thomas AA, Rackley RR, Lee U, et al. Urethral diverticula in 90 female patients: a study with emphasis on neoplastic alterations. J Urol 2008; 180:2463.
  13. Rovner ES, Wein AJ. Diagnosis and reconstruction of the dorsal or circumferential urethral diverticulum. J Urol 2003; 170:82.
  14. Tsivian M, Tsivian A, Shreiber L, et al. Female urethral diverticulum: a pathological insight. Int Urogynecol J Pelvic Floor Dysfunct 2009; 20:957.
  15. DAVIS HJ, TELINDE RW. Urethral diverticula: an assay of 121 cases. J Urol 1958; 80:34.
  16. Aspera AM, Rackley RR, Vasavada SP. Contemporary evaluation and management of the female urethral diverticulum. Urol Clin North Am 2002; 29:617.
  17. Chou CP, Levenson RB, Elsayes KM, et al. Imaging of female urethral diverticulum: an update. Radiographics 2008; 28:1917.
  18. Kim B, Hricak H, Tanagho EA. Diagnosis of urethral diverticula in women: value of MR imaging. AJR Am J Roentgenol 1993; 161:809.
  19. Daneshgari F, Zimmern PE, Jacomides L. Magnetic resonance imaging detection of symptomatic noncommunicating intraurethral wall diverticula in women. J Urol 1999; 161:1259.
  20. Lorenzo AJ, Zimmern P, Lemack GE, Nurenberg P. Endorectal coil magnetic resonance imaging for diagnosis of urethral and periurethral pathologic findings in women. Urology 2003; 61:1129.
  21. Neitlich JD, Foster HE Jr, Glickman MG, Smith RC. Detection of urethral diverticula in women: comparison of a high resolution fast spin echo technique with double balloon urethrography. J Urol 1998; 159:408.
  22. Blander DS, Rovner ES, Schnall MD, et al. Endoluminal magnetic resonance imaging in the evaluation of urethral diverticula in women. Urology 2001; 57:660.
  23. Foster RT, Amundsen CL, Webster GD. The utility of magnetic resonance imaging for diagnosis and surgical planning before transvaginal periurethral diverticulectomy in women. Int Urogynecol J Pelvic Floor Dysfunct 2007; 18:315.
  24. Dwarkasing RS, Dinkelaar W, Hop WC, et al. MRI evaluation of urethral diverticula and differential diagnosis in symptomatic women. AJR Am J Roentgenol 2011; 197:676.
  25. Chung DE, Purohit RS, Girshman J, Blaivas JG. Urethral diverticula in women: discrepancies between magnetic resonance imaging and surgical findings. J Urol 2010; 183:2265.
  26. Siegel CL, Middleton WD, Teefey SA, et al. Sonography of the female urethra. AJR Am J Roentgenol 1998; 170:1269.
  27. Gerrard ER Jr, Lloyd LK, Kubricht WS, Kolettis PN. Transvaginal ultrasound for the diagnosis of urethral diverticulum. J Urol 2003; 169:1395.
  28. Lee JW, Fynes MM. Female urethral diverticula. Best Pract Res Clin Obstet Gynaecol 2005; 19:875.
  29. Golomb J, Leibovitch I, Mor Y, et al. Comparison of voiding cystourethrography and double-balloon urethrography in the diagnosis of complex female urethral diverticula. Eur Radiol 2003; 13:536.
  30. Jacoby K, Rowbotham RK. Double balloon positive pressure urethrography is a more sensitive test than voiding cystourethrography for diagnosing urethral diverticulum in women. J Urol 1999; 162:2066.
  31. Dmochowski RR, Ganabathi K, Zimmern PE, Leach GE. Benign female periurethral masses. J Urol 1994; 152:1943.
  32. Greco A, Giammò A, Tizzani A. [Nephrogenic adenoma arising from an urethral diverticulum in a female. Report of a case and review of the literature]. Minerva Urol Nefrol 1999; 51:39.
  33. Fortunato P, Schettini M, Gallucci M. Diagnosis and therapy of the female urethral diverticula. Int Urogynecol J Pelvic Floor Dysfunct 2001; 12:51.
  34. Delancey, JO. Anatomy of the Female Bladder and Urethra. In: Ostergard's Urogynecology and Pelvic Floor Dysfunction, 5th ed, Bent, AE (Ed), Lippincott Williams & Wilkins, Philadelphia PA 2003. p. 3.
  35. Ganabathi K, Leach GE, Zimmern PE, Dmochowski R. Experience with the management of urethral diverticulum in 63 women. J Urol 1994; 152:1445.
  36. Swierzewski SJ 3rd, McGuire EJ. Pubovaginal sling for treatment of female stress urinary incontinence complicated by urethral diverticulum. J Urol 1993; 149:1012.
  37. Migliari R, Pistolesi D, D'Urso L, Muto G. Recurrent pseudodiverticula of female urethra: five-year experience. Urology 2009; 73:1218.
  38. Bennett SJ. Urethral diverticula. Eur J Obstet Gynecol Reprod Biol 2000; 89:135.
  39. Scarpero HM, Dmochowski RR, Leu PB. Female urethral diverticula. Urol Clin North Am 2011; 38:65.
  40. Porpiglia F, Destefanis P, Fiori C, Fontana D. Preoperative risk factors for surgery female urethral diverticula. Our experience. Urol Int 2002; 69:7.
  41. Ljungqvist L, Peeker R, Fall M. Female urethral diverticulum: 26-year followup of a large series. J Urol 2007; 177:219.
  42. Lapides J. Transurethral treatment of urethral diverticula in women. J Urol 1979; 121:736.
  43. Spence HM, Duckett JW Jr. Diverticulum of the female urethra: clinical aspects and presentation of a simple operative technique for cure. J Urol 1970; 104:432.
  44. Moran PA, Carey MP, Dwyer PL. Urethral diverticula in pregnancy. Aust N Z J Obstet Gynaecol 1998; 38:102.