Acquired Male Urethral Diverticula: Diagnosis and Surgical Management

Abstract

Background: A urethral diverticulum (UD) constitutes a localised saccular dilation that forms out of any point in the urethra’s length, contiguous with the true urethral lumen through an orifice with a variable size neck. Disturbance of urine drainage from this outpouching leads to urinary stasis, recurrent urinary tract infections, lithiasis formation, an increase in UD size, urinary leakage or fistulas, incontinence, or even a palpable penoscrotal mass. UD occurs far more frequently in women and is very rare in men, with the incidence and prevalence in males remaining largely unknown. Objective: The purpose of this paper is to present an updated review of acquired male UD, according to clinical presentation, diagnostic imaging findings, management, complications, and outcomes. Material and Methods: Literature searches were conducted using Medline, Embase, and Cochrane databases in June 2015 to identify papers related to acquired male UD, concerning type, aetiology, presentation, radiologic and/or surgical intervention, and outcomes. Discussion: The most common symptoms are obstructive lower urinary tract symptoms along with haematuria. Additionally, both congenital and acquired diverticula at the penoscrotal angle are frequent. Diagnosis alternates between physical examination and specific imaging, with individualised treatment now being standard practice varying with the location and size of the diverticulum. Besides conservative and observational follow-up, endoscopic and open surgical techniques are the selected definitive management options. Conclusion: An acquired male UD is rare and must be considered in the differential diagnosis of suspicious penile and scrotal masses. If there is significant urinary stasis, recurrent urinary tract infections, or urethral calculi, a rigorous and thorough clinical examination followed by surgical correction is most often standard procedure, allowing for treatment of symptoms and aetiology simultaneously. Reconstructive urethral surgical corrections are very complex and require a specialised approach, often found only in high-volume surgical centres.