Anterior Urethral Diverticulum Research Articles

Case report of pediatric anterior urethral diverticulum arising at the bulbar urethra

Congenital anterior urethral diverticulum at the bulbar urethra is a rare entity. Accumulation of urine within the diverticulum causes obstruction to the free flow of urinary stream and resultant symptoms such as difficulty in micturition, dribbling of urine, and urinary tract infection. Correct recognition of this condition is important to initiate early surgical treatment. Micturating cystourethrogram and ultrasonography are imaging modalities of choice for identification and surgical planning of this entity.

Congenital anterior urethral diverticulum in children: case series and review of the literature

BackgroundCongenital anterior urethral diverticulum (CAUD) is a rare condition in children. This condition can present at any age; however, it is more commonly identified in infants and older children. The patient may present with difficulty in micturition, dribbling of urine, poor urinary stream, or urinary tract infection. Children with large anterior urethral diverticulum with poor spongiosal support may also complain of cystic ventral penile swelling during micturition.MethodsIn this series, we report seven such cases of congenital anterior urethral diverticulum treated over a period of 12 years (2008–2020). All cases presented to the Pediatric Surgery Department with dysuria, dribbling of urine, recurrent urinary tract infection, and/or fluctuant ventral penile swelling. They were further evaluated with retrograde urethrography with micturating cysto-urethrogram and cysto-urethroscopy.ResultsThree cases had anterior urethral valves that were managed by cystoscopic fulguration of valves. Surprisingly, all these three cases had concomitant posterior urethral valves, while the other four cases presented with relatively larger and saccular anterior urethral diverticulum required excision of the diverticulum and primary urethral reconstruction.ConclusionsThe cases with congenital anterior urethral diverticulum secondary to anterior urethral valves may also be associated with posterior urethral valves as seen in our case series. Surgeons should be aware of this association, and both valves should be fulgurated in the same sitting. A larger and saccular anterior urethral diverticulum requires excision and urethroplasty as a definitive procedure.

Congenital anterior urethral valves and diverticulum: A case series and association with posterior urethral valves

There is limited data regarding long-term results and associated complications in patients with anterior urethral valve (AUV) and diverticulum (AUD). We retrospectively reviewed AUV/AUD cases managed by us between the year 2002-2020. Presentation, investigations, management, concomitant posterior urethral valves (PUV) and pre-operative characteristics predisposing to long-term poor renal outcome were assessed. There were 27 patients [AUV (n=11); AUD (n=16)] with 5 having concomitant PUV. All presented with poor urinary stream and dribbling at a median age of 1-year (5 days-12 years). More patients with AUD (9 of 16, 56.3%) especially with concomitant PUV presented at ≤1-year-age as compared to those with AUV (4 of 11, 36.4%). Concomitant PUV and AUD cases (n=3) had characteristic micturating cystourethrography (MCUG) features. (Fig. 1A) Retrograde urethrography delineated the valve and distal urethra dimensions better (Fig.1B, C). Urethral hypoplasia distal to the valve (n=4) urethral duplication (n=1) were associated (Fig.1D). Syringocele was ruled out in proximal AUD by absence of filling defect on MCUG and appearance of urethral walls on urethrocystoscopy. Serum creatinine > 1mg/dL (n=5), trabeculated bladder (n=12), and vesicoureteral reflux (VUR) (n=12) was noted at presentation. Diverticulum/valve excision (n=13, 48.2%), fulguration alone (n=12, 44.4%) and primary urinary diversion (n=2, 7.4%) were performed. Follow up (range:3 mo-19 years), showed deranged renal function tests (n=6), VUR (n=4), impaired renal function on scans (n=8), and lower urinary tract dysfunction (n=7). Outcome with and without associated PUV was similar. Long term results were better in AUV compared to AUD. Pre-operative raised serum creatinine (>1mg/dL), trabeculated bladder, non-dilated posterior urethra on MCUG and bilateral impaired renal function on scans had significant association with follow up eGFR less than 60ml/kg/min. Co-existing PUV and AUD present earlier and have specific imaging findings. In proximal AUD, possibility of syringocele should be kept in mind, as they have similar presentation and imaging. Concomitant PUV did not alter prognosis. Secondary effects on bladder and renal function were more with AUD. Follow up eGFR less than 60ml/kg/min was associated with pre-operative elevated serum creatinine, trabeculated bladder, non-dilated posterior urethra, and bilateral impaired renal function on scans.

Case Report: Neonatal Urinary Ascites Without Hydronephrosis: A Rare Case of Anterior Urethral Valve and Diverticulum in Preterm Newborn

The deformation of congenital obstruction of the anterior urethra is rare in male infants. The anterior urethral valve (AUV) and diverticulum are not common causes of distal urethral obstruction, which may be significant but difficult to diagnose in time. We describe a premature infant who was diagnosed with AUV as part of a diverticulum in the anterior urethra and was presented as massive urinary ascites without hydroureters and hydronephrosis. After indwelling abdominal tube and urinary catheterization, the infant’s massive ascites were resolved, while urethral obstruction had successful treatment by Holmium laser. We suggest that the presence of urinary ascites in fetuses and neonates should be considered as a warning against urinary malformations.

Congenital anterior urethral diverticula with posterior urethral valve: rare combination in a neonate: a case report

Congenital Anterior Urethral Diverticulum (CAUD) is defined as a cystic dilatation of the anterior urethra and is one of the rare causes of bladder outlet obstruction. The association of this urethral anomaly with the posterior urethral valve is extremely rare. In this case, we found the association of congenital urethral diverticulum and posterior urethral valve and we aimed to present it.

Congenital anterior urethral diverticulum of the distal penis: A case report

Congenital Anterior Urethral Diverticulum (CAUD) is a rare congenital anomaly. We describe a case of CAUD in a 3-year-old male child, with a history of recurrent urinary tract infections, referred to our clinic for diagnosis and treatment of penile swelling and weak micturition. On physical examination, a painless oval area of swelling, located on the ventral and left lateral aspect of the penis and extending from the corona to the base of the penis, was observable. The swelling was fluctuating in nature and compressible, collapsing completely with applied pressure, with urine dripping through the urethral meatus. Cytobacterial urinalysis, routine blood analysis, and renal analysis were normal. Ultrasound examination revealed normal kidneys and bladder. A retrograde urethrogram revealed a large anterior urethral diverticulum. The patient underwent open diverticulectomy with urethroplasty. The recovery was uneventful and the catheter was removed on postoperative day 10. Six months post-surgery, the patient had no complaints. One difficulty in the management of CAUD is distinguishing it from other anterior urethral malformations. Treatment of a CAUD is informed by the type of diverticulum and should be performed early to avoid complications associated with urinary obstructio

Congenital anterior urethral diverticula with posterior urethral valve: rare combination in a neonate: a case report

Congenital Anterior Urethral Diverticulum (CAUD) is defined as a cystic dilatation of the anterior urethra and is one of the rare causes of bladder outlet obstruction. The association of this urethral anomaly with the posterior urethral valve is extremely rare. In this case, we found the association of congenital urethral diverticulum and posterior urethral valve and we aimed to present it.

Late diagnosed congenital anterior urethral diverticulum in a male teenager: A case report

Late diagnosed congenital anterior urethral diverticulum in a male teenager: A case report

Are anterior urethral valve and anterior urethral diverticulum two separate entities: A radiological and endoscopic review

Anterior urethral valve (AUV) and anterior urethral diverticulum (AUD) are two rare causes of anterior urethral obstruction with variable presentation and anatomy. Their existence as the same or different entity is still debatable, and management has not yet been standardized. This study is a retrospective review of cases diagnosed with anterior urethral obstruction and correlation of radiological and endoscopic anatomy of AUV and AUD. A retrospective review of cases diagnosed with AUV and AUD, between May 2013 and February 2020 is presented. The presentation, laboratory, radiological and endoscopic anatomy along with the management required was reviewed. A special emphasis has been given on the correlation of radiological and endoscopic anatomy and an attempt has been made to standardize the management. A total of 8 patients with age ranging from 2 months to 9 years were reviewed. Poor urinary stream and recurrent UTI was the commonest presentation. The anatomy of the anterior urethra on VCUG (voiding cystourethrogram) and Urethrocystoscopy was correlated. Two sets of patients were identified. In the first set, five cases on endoscopy had findings of the classical valve-like fold in the anterior urethra with immediate proximal dilation of the urethra giving the appearance of a 'pseudodiverticula' without any definite opening. In three of these cases, endoscopic findings correlated well with radiological findings of 'pseudodiverticula' in which dilated proximal urethra formed an obtuse angle with the ventral floor of the urethra. The other set of four patients had a 'true diverticula' on endoscopy with a well-defined mouth and prominent distal lip, correlating well with radiological findings of a 'true diverticula' forming an acute angle with the ventral floor of the urethra. One case on endoscopy had both an anterior urethral valve with a proximal 'pseudodiverticula and a large wide-mouthed bulbar 'true diverticula'. All the patients with classical valves were successfully treated using a resectoscope while two patients with 'true diverticula' were successfully managed by incising the distal lip. One of the patients previously managed for the posterior urethral valve (PUV) had both classical valves in the anterior urethra with proximal 'pseudodiverticula' and a bulbar 'true diverticula'. The AUV was ablated with a resectoscope while 'true diverticula' required diverticulectomy. All the patients after follow up of 3 months-8 years, were asymptomatic except the one with 'true diverticulum' who remained symptomatic after TUR (Trans-urethral resection) and required vesicostomy. AUV and AUD both can cause obstructive uropathy. The proximal dilatation related to AUV cannot be labeled as a 'true diverticula', which lacks a classical orifice. The distal obstructing lip of 'true diverticula' should not be confused with a classical mucosal valve-like fold seen in AUV. While AUV and small AUD can be treated with endoscopic ablation, large diverticula as a result of wide spongiosal defects require surgical excision. A good understanding of their radiological and endoscopic anatomy is required to differentiate them and decide for appropriate management. Based on our experience, AUV and AUD should be differentiated and should be considered as two separate entities.

A new born with anterior urethral diverticulum and posterior urethral valve

A new born with anterior urethral diverticulum and posterior urethral valve

Urethral Catheter Induced Huge Anterior Urethral Diverticulum

We report a 22-year old gentleman who presented with postmicturition urinary dribbling for nearly 1 year along with urinary urgency and frequency. He had a history of brain tuberculosis 2 years back and was hospitalized for 4 months with a urethral catheter. Examination revealed a 3 cm cystic swelling in the penoscrotal junction. On pressing the sac, a gush of urine came out through the urethral meatus. A micturating cystourethrogram revealed a huge anterior urethral diverticulum. Cystoscopic assessment also confirmed the diagnosis and demonstrated transillumination. He subsequently underwent surgical excision of the diverticulum and is doing well on follow-up.

Giant urethral calculus in anterior urethral diverticulum: a case report

BackgroundIn this case report, giant calculus in the urethral diverticulum was found through ureteroscopy investigation, the pneumatic lithotripsy combined with ultrasound lithotripsy (PLCUL) was successfully performed to break down this rare and giant urethral calculus in the diverticulum without open surgery.Case presentationA 82-year-old male presented to the urology department, complaining of frequent urination and dysuria. One giant, dark brown stone (6.5 × 6 × 5.5 cm) was revealed in the diverticulum of the anterior urethra using combination of local ultrasound, pelvic Computer Tomography (CT) and Magnetic Resonance Imaging (MRI). The stone was then successfully broken down via the PLCUL, and the emptied anterior urethral diverticulum was left untreated. In the 18 months’ follow-up, no new calculus was found in urethral tract, anterior diverticula became gradually smaller, eventually disappeared.ConclusionIn the treatment of giant calculus in the urethral diverticulum, this case report provides an effective method of lithotripsy in the clinical trials.

Giant congenital anterior urethral diverticulum with left side vesicoureteral reflux: A case report

Anterior urethral diverticulum is a rare entity. A 12 year old boy presented with poor stream, recurrent urinary tract infection and fluctuant penile swelling at penoscrotal junction. Diagnosis of anterior urethral diverticulum with the left vesicoureteral reflux was made by retrograde urethrogram and micturating cystourethrogram. A giant diverticulum requires open diverticulectomy with urethral reconstruction which was done successfully without any complication in this case.

Congenital anterior urethral diverticulum

Abstract Congenital anterior urethral diverticulum is a very rare cause of lower urinary tract obstruction. It usually occurs at the penoscrotal junction but also may occur at the penile urethra. Two months old male baby presented with soft cystic swelling at the anterior urethra ballooning during micturition. Diagnosis was confirmed by MCUG and ultrasonography. Open diverticulectomy was done.

Congenital anterior urethral diverticulum in male child

Congenital anterior urethral diverticulum is an uncommon condition in males. In my series a 15 years old boy with congenital anterior urethral diverticulum was presented with urinary symptoms and ventral penile swelling. The diagnosis was made on retrograde urethrogram (RGU) and micturiting cystourethrogram (MCU). The patient had normal renal function. Open diverticulectomy and primary urethral reconstruction was carried out uneventfully.
 CBMJ 2018 January: Vol. 07 No. 01 P: 45-47

Once in a Blue Moon, Congenital Anterior Urethral Diverticulum

AbstractAnterior urethral valves (AUVs) are rare congenital anomalies causing lower urinary tract obstruction in children. Although they are referred to as valves, these obstructive structures often occur in the form of a diverticulum. Congenital anterior urethral diverticulum (CAUD) is an uncommon/rare entity in children which can lead to obstructive lower urinary tract symptoms and urosepsis. Over the past 20 years, more than 260 cases have been reported. However, most cases are diagnosed on prenatal ultrasonography (USG) in early life if patients present with bilateral hydronephrosis and/or azotemia. Diagnosis is by ureteroscopy and radiological imaging. Surgical treatment can be open or endoscopic. Here, we report a new case of CAUD and discuss its clinical presentation, diagnosis, and management. A brief review of the literature is also presented.

Congenital Diverticulum at the Proximal Part of Penile Urethra with Secondary Calculus

Voiding dysfunction and lower urinary tract symptoms (LUTS) in children due to congenital anomalies of urogenital system is common, but congenital anterior urethral diverticulum (CAUD) in male is very rare. Sometimes the problem is associated with anterior urethral valve. CAUD with secondary stone is rare. Here we report a case of a 12-year-old male child with obstructive symptoms. It was treated by excision of diverticulum, removal of stone and primary repair.J Enam Med Col 2017; 7(3): 162-164

Congenital anterior urethral diverticulum presenting as a scrotal mass in a two-year-old child.

Here, we describe a case of congenital anterior urethral diverticulum (CAUD) in a two-year-old boy, who presented with right inguinoscrotal swelling that mimicked a spermatic cord cyst or hydrocele. Accurate diagnosis was made intraoperatively by retrograde urethrography. Open diverticulectomy and primary urethroplasty were performed for its management. The clinical presentation, diagnosis, and the management of this rare condition is discussed.

131 Congenital anterior urethral diverticulum presenting as a scrotal mass in children

131 Congenital anterior urethral diverticulum presenting as a scrotal mass in children

A congenital anterior urethral diverticulum associated with obstructive urinary symptoms in a 1-year-old male child: A case report and review of the literature

Congenital anterior urethral diverticula are rarely found in children. We present the case of a 1-year-old male child with a congenital anterior urethral diverticulum. This condition can lead to obstructive lower urinary tract symptoms and urosepsis. The clinical presentation, diagnosis, and management of this rare condition are discussed in this report. The diagnosis was made using retrograde urethrography. Patient was treated with open diverticulectomy and urethroplasty.