Anterior Urethral Diverticulum Research Articles

Congenital Anterior Urethral Diverticulum: Antenatal Diagnosis With Subsequent Neonatal Endoscopic Management

Congenital anterior urethral diverticulum is a rare cause of urethral obstruction in boys. We report on the antenatal diagnosis of this rare phenomenon, making this the sixth prenatally diagnosed case in the English literature (to the best of our knowledge). Our initial prenatal assessment, postnatal endoscopic management, along with the eventual clinical course is outlined. The embryologic theories, differential diagnosis, literature review, imaging, and treatment modalities of this entity are discussed.

Anterior Urethral Valve and Diverticulum in a Neonate with Urinary Tract Infection

Introduction:Anterior urethral valve (AUV) is a rare congenital anomaly that can cause obstructive uropathy. AUV can lead to variable urinary tract symptoms, and if left untreated, it can result in end-stage renal disease. AUV should be immediately evaluated and managed. Herein, we present a neonate with AUV and diverticulum, who was treated by cystoscopy. Case report:A 11-day-old boy was referred to the nephrology department for evaluation of urinary tract infection, which was developed 2 days prior to admission. Pregnancy and routine ultrasound (US) were normal, and urinalysis showed pyuria. Routine investigations included blood urea nitrogen, serum creatinine, electrolyte panel, urine analysis (UA), and urine culture (UC). Abdominal US examination displayed a normal bladder with normal kidneys. A voiding cystourethrogram (VCUG) showed an anterior urethra diverticulum with dilation of the proximal urethra and trabeculated bladder; however, no vesicoureteral reflux was observed. Finally, the patient underwent endoscopy. Discussion: AUV is a congenital mucosal fold, located distally to the membranous urethra. AUV can be located anywhere distal to the membranous urethra and is found in bulbar urethra (40%), penoscrotal junction (30%), pendulous urethra (30%), and occasionally in the fossa navicularis, respectively. The exact etiology of this disease is unclear. AUV with associated diverticulum is a rare congenital urethral anomaly that can lead to penile swelling, urethral obstruction, urinary retention, incontinence, nocturnal enuresis, bladder rupture, and end-stage renal disease. Depending on the severity of anatomical obstruction, this condition may present soon after birth or later during childhood. VCUG is the most important imaging technique for the evaluation of urethral abnormalities. Congenital AUV in children has a generally good prognosis, but may occasionally result in poor renal outcomes such as renal insufficiency, renal failure, and patient‘s death.

Congenital anterior urethral diverticulum

Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair.

Scrotal pop off in a congenital anterior urethral diverticulum

Introduction and objectiveCongenital anterior urethral diverticulum is a rare entity. This teaching video shows the scrotal pop-off mechanism for an anterior urethral diverticulum and the unique voiding pattern of a boy who empties his bladder by compression of his scrotum. The findings during urethroscopy and open reconstruction are also demonstrated. Patient and methodsA four-year-old boy presented to the clinic with a poor urinary stream and scrotal swelling during voiding. Physical examination during voiding revealed a dumbbell-shaped anterior urethral diverticulum with scrotal pop off and preserved renal function. ResultsOpen excision of the scrotal part of diverticulum was performed. Urethroplasty was conducted using a de-epithelialised diverticular wall flap from the penobulbar urethra. On follow up the boy voided with a good flow and resolution of symptoms. ConclusionScrotal pop off with completion of voiding by manual compression of the diverticulum may preserve bladder and renal function. The preferred treatment of anterior urethral diverticulum is open excision of the diverticulum and reconstruction. The wall of the diverticulum may be used to reinforce the repair ventrally, where the corpus spongiosum is deficient.

Multiple urethral anomalies: Anterior urethral diverticulum, posterior urethral valves, and distal hypospadias

We report an infant with antenatally detected bilateral hydroureteronephrosis and a penile cyst who was eventually diagnosed with an anterior urethral diverticulum (AUD), subcoronal hypospadias, and posterior urethral valves (PUV) after birth. To our knowledge, there are no reports where all three anomalies have been found to coexist. As per urethral catheterisation was difficult, cystoscopy-guided catheterisation was performed. On retracting the complete foreskin, a subcoronal hypospadias was identified. The AUD was resected partially, and during a cystoscopy for completion of AUD resection, a dilated anterior urethra was found collapsed, and thin PUV were identified and divided. He remains well at nine months with an improving renal cortical thickness. The vesicoureteric reflux had resolved.

Giant anterior urethral diverticulum with a calculus masquerading as left inguinal hernia: A missed diagnosis, a lesson to learn

Congenital anterior urethral diverticulum is an infrequent but important cause of infravesical obstructive uropathy in children. Clinical spectrum usually includes obstructive or irritative urinary symptoms or penile ballooning during the act of micturition. We share our experience in a case of giant anterior urethral diverticulum with a contained calculus presenting as a huge inguino-scrotal swelling and masquerading as left inguinal hernia. The fluctuation in the size of the swelling related to the act of micturition was mistaken for cough impulse. He was subjected to a left inguinal herniotomy, following which he developed urine leak from the surgery wound and was subsequently referred to our centre for further management. The importance of a detailed history, meticulous physical examination, and diagnostic imaging has been stressed. The surgical approach in such cases has also been highlighted.

Congenital anterior urethral diverticulum co-existing with phimosis: A case report and review of literature

Congenital anterior urethral diverticulum (CAUD) is a rare congenital blind ended out pouching of the urethral through the corpus spongiosium. We report its coexistence with phimosis in a 7-year-old boy who presented with difficulty in passing urine. His prepuce was not retractable and balloons at voiding. Suspected associated CAUD was confirmed at circumcision. His voiding became normal with resolution of lower urinary tract symptoms after treatment. The related literatures were reviewed. The symptoms of the two conditions mimic one another and the diagnosis of phimosis which is clinical may overshadows CAUD with its needed confirmatory imaging studies. CAUD can coexist with phimosis and high index of suspicion helps in the management. Diverticulectomy and urethroplasty with circumcision at the same sitting is curative.

A rare case of giant urethral calculus and multiple urethral diverticulum

Urethral stones in adults are rare and usually encountered with urethral stricture or diverticulum. We report a 54 years old gentleman who presented with urinary retention due to a large urethral calculus impacted in bulbar urethra with multiple stones in anterior and posterior urethral diverticulum. On examination a mass of size 5.5cmx4cmx3cm was palpable at anterior perineum with a fistulous tract from which pus was oozing out. On retrograde urethrogram a large urethral calculus with bulbar diverticulum and multiple radio opacity in prostatic area were revealed. Patient was managed by suprapubic cystostomy initially and later on by external urethrotomy, diverticulectomy, urethroscopic removal of multiple stones in prostatic urethral diverticulum and urethroplasty. Journal of College of Medical Sciences-Nepal,2012,Vol-8,No-2, 46-48 DOI: http://dx.doi.org/10.3126/jcmsn.v8i2.6838

Acquired Male Urethral Diverticula: Presentation, Diagnosis and Management

We describe the etiology, presentation, treatment and outcomes of men diagnosed with an acquired urethral diverticulum. We retrospectively analyzed the records of men with an acquired urethral diverticulum in an 11-year period (2000 to 2011) at a tertiary care reconstructive practice. Patient demographics, history, presentation, anatomical details such as diverticulum size and location, management and outcomes were recorded. Technical success was defined as unobstructed urination without urinary tract infection. A total of 22 men with an acquired urethral diverticulum were included in analysis. Median age at presentation was 48.5 years (range 18 to 86). Most commonly, patients presented with recurrent urinary tract infection, urinary dribbling, incontinence or a weak urinary stream. Of the 22 men 12 (54.5%) underwent urethral diverticulectomy and urethroplasty, 3 (13.5%) underwent ileal conduit urinary diversion and 7 (32%) were treated nonoperatively. Select cases were managed conservatively when the urethral diverticulum was confirmed in a nonobstructed urethra, it was small or asymptomatic and it could be manually emptied after voiding. At a mean followup of 2.3 years there was a 91% urethral diverticulum recurrence-free rate. Acquired male urethral diverticula are rare but should be considered when there is recurrent urinary tract infection, obstructive voiding symptoms, a history of hypospadias, urethral stricture or trauma, or prolonged urethral catheterization. Treatment options may include surgical excision of the urethral diverticulum or urinary diversion. Some patients may be adequately treated nonoperatively with post-void manual decompression.

Anterior Urethral Valve and Diverticulum in a Neonate with Febrile Urinary Tract Infection

Anterior urethral valve is a rare congenital anomaly that can cause obstructive uropathy. Herein, we report a case of an anterior urethral valve that led to the development of febrile urinary tract infection in a neonate.

Anterior urethral diverticulum with multiple stones presenting as scrotal mass

Anterior urethral diverticulum with multiple stones presenting as scrotal mass

Congenital Anterior Urethral Diverticulum in Children: A Case Report and Review

Congenital anterior urethral diverticulum (CAUD) is an uncommon condition in children. We describe 2 patients of CAUD who presented with ventral penile swelling; in one, the site of swelling was just proximal to corona which is quite rare. The diagnosis was made on USG and MCU. Both patients had normal renal function. Open diverticulectomy and primary repair was done in both patients.

Congenital Anterior Urethral Diverticulum in a Male Teenager: A Case Report and Review of the Literature

We present the case of a 13-year-old boy with a congenital anterior urethral diverticulum. This is a rare condition in males which can lead to obstructive lower urinary tract symptoms and urosepsis. Diagnosis is by urethroscopy and radiological imaging. Surgical treatment can be open or endoscopic. Long-term followup is required to check for reoccurrence of the obstruction.

Pictorial essay: Congenital anomalies of male urethra in children

Congenital anomalies of the male urogenital tract are common. Some lesions like posterior urethral valve or anterior urethral diverticulum tend to present early in infancy and are often easily diagnosed on conventional contrast voiding cystourethrograms. Other conditions like posterior urethral diverticulum or utricle can be relatively asymptomatic and therefore present late in childhood. We present the spectrum of imaging findings of common and uncommon anomalies involving the male urethra. Since the pediatric radiologist is often the first to make the diagnosis, he or she should be well aware of these conditions.

Anterior urethral valves and diverticulum

Anterior urethral valves with associated urethral diverticulum is a rare but important cause of infravesical obstructive uropathy in children. This condition can be a cause of significant morbidity and can even lead to end-stage renal disease. This rare condition should be included in the differential diagnosis while evaluating male infants with infravesical obstructive uropathy.

Congenital anterior urethral valves and diverticula: Diagnosis and management in six cases

Anterior 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. The urethra in these cases shows saccular or bulbar dilatation known as anterior urethral diverticulum (AUD). They typically occur where there is a defect in the corpus spongiosum, leaving a thin-walled urethra. This segment of the urethra balloons out during voiding, simulating a mass that is sometimes visible along the ventral wall of the penis. The swelling is fluctuant and urine dribbles from the meatus on compression. The present study highlights the clinical approach in identifying the condition and its treatment options, especially for those, presenting with urethral diverticula. We have studied children with congenital anterior urethral valves and diverticula. Six patients of AUVs with diverticula were admitted during the period of 2000-2007 and were prospectively evaluated. The mean age of presentation was 16 months (15 days to 4 years). Straining at micturition and a palpable penile swelling were the most common presenting features. The diagnosis was established by voiding cystourethrogram (VCUG) and supported by ultrasonography (USG). All patients were treated with single-stage open surgical excision except one who died preoperatively due to urosepsis. Initial lay opening of the penoscrotal urethra and delayed repair were done in one patient. The surgical outcome was successful in all but one patient, who died of delayed presentation with severe back pressure changes, urinary ascitis and urosepsis. On long-term follow-up, all patients demonstrated good stream of urine. The renal functions were normal and the patients had no evidence of urinary infections. We propose that, the patients of AUVs, if not excessively delayed for treatment are otherwise well in terms of general condition as opposed to patients of posterior urethral valves. The diagnosis is easily established by VCUG and the severity is revealed by a sonogram. Open surgical excision is the method of choice for patients with a urethral diverticulum; however, cystoscopic fulguration is also feasible in selected patients. The outcome is excellent with minimal morbidity and mortality.

Scrotal Mass with Bladder Outlet Obstruction

A 71-year-old man presented with a 6-cm scrotal mass and urinary retention. He had had progressive voiding difficulty after an untreated urethral injury in a traffic accident 15 years before presentation. Retrograde urethrography showed an anterior urethral diverticulum with stone formation. He underwent open diverticulectomy and recovered well. Pathologic examination revealed the diverticulum was lined by granulation tissue. Male urethral diverticula are rare and can be congenital or acquired. An acquired urethral diverticulum, as shown in this case, often results from infection, stricture, or trauma. The diagnosis requires a detailed history, physical examination, imaging studies, and pathologic examination.

Giant anterior urethral diverticulum in a neonate

Congenital anterior urethral diverticulum is an uncommon condition that tends to present in older children with signs of chronic urinary problems. A neonate presented following recurrent collapse, and cystography revealed a giant urethral diverticulum. The diverticulum was incised at cystoscopy, leading to a full recovery.

Congenital anterior urethral diverticulum in an adolescent boy with obstructive urinary symptoms

A case of anterior urethral diverticulum in a 12 years old boy who presented with obstructive urinary symptoms is described. The diagnosis was made on retrograde urethrography. Open diverticulectomy and urethroplasty was done with complete excision of obstructing anterior valve. The clinical presentation, diagnosis, and management of this rare condition is discussed.

Acquired Male Anterior Urethral Diverticulum with Giant Calculi and Cutaneous Fistula

Urethral diverticulum is a relatively uncommon abnormality for a man. We report here on a case of acquired anterior urethral diverticulum with giant calculi and cutaneous fistula in a 64-years old male patient who had suffered from urethritis 10 years previously. Retrograde urethrography and urethroscopy confirmed the anterior urethral diverticulum with giant calculi, and these procedures ruled out the presence of any associated obstructive urethral anomalies. We performed urethral diverticulectomy, with removal of the calculi, and then we performed urethroplasty.