Female Urethral Diverticulum Research Articles

Stones in a female urethral diverticulum

Urinary stones in female urethral diverticulum are rarely seen. We report a 52-year-old woman who presented with irritative lower urinary tract symptoms and recurrent infections. The diverticulum was approached via vaginal route and the extraction of the stone was successful. The patient has been well, with no dysuria, dyspareunia, incontinence for 3-months follow-ups.

Revival of a Surgical Technique: Marsupialization of Female Urethral Diverticula

<h3>Study Objective</h3> To review the etiology, incidence, basic evaluation and the current treatment options for female urethral diverticula. As well as to describe a case-presentation of female urethral diverticulum and to demonstrate a technique for marsupialization. <h3>Design</h3> A case presentation and educational surgical video <h3>Setting</h3> Single academic institution <h3>Patients or Participants</h3> Single patient <h3>Interventions</h3> Marsupialization of female urethral diverticulum <h3>Measurements and Main Results</h3> We present a case of a 31-year-old female with a painful anterior vaginal wall mass, urinary urgency/frequency and some leakage of urine during pregnancy. MRI was notable for a 3.7 × 2.7cm anterior vaginal wall mass concerning for urethral diverticulum. After her vaginal delivery she underwent aspiration for decompression; however, she then had recurrence of the diverticulum 6-weeks later resulting in repeat drainage. At that time, she referred to Urogynecology. Her exam was notable for a recurrent diverticulum. She as counseled extensively on her options for treatment and decision was ultimately made to proceed with marsupialization due to her current social circumstances, desire not to undergo a more complex surgery nor to have prolonged Foley catheter use. She underwent an uncomplicated marsupialization of her urethral diverticulum and was discharged home the same day and her foley was removed at home on postoperative day zero. She was seen for follow-up at 2-weeks and 6-weeks and was healing well without urinary incontinence or notable recurrence symptoms or diverticulum. <h3>Conclusion</h3> Marsupialization is a simple, quick, and effective treatment option for urethral diverticula with minimal surgical risk and should be considered in appropriately counseled patients as an initial treatment option for female urethral diverticula.

Diagnosis of female urethral diverticulum using pelvic floor ultrasound and comparison with voiding cystourethrogram (imaging study).

The purpose of this study was to evaluate the sensitivity and specificity of pelvic floor ultrasound (PFUS) in the diagnostic work-up of female urethral diverticulum (UD) and to compare results of PFUS with voiding cystourethrogram (VCUG). We retrospectively reviewed our database of patients, who received VCUG and PFUS for the diagnosis of UD. A total of 196 consecutive female patients with a minimum of one symptom, such as a lower urinary tract symptom (LUTS), postmicturition dribble, dyspareunia and recurrent urinary tract infection (UTI) who underwent initial diagnostics with VCUG and PFUS were selected. Diagnostic performance of both procedures, which included size, complexity, echogenicity. and content were compared. Recurrent UTI and LUTS were the most common symptoms, which were present in 165 (84%) and 163 patients (83%) respectively. Final diagnosis of UD was based on PFUS and VCUG findings in 69 (35%) and 58 (30%) cases respectively. Based on our study cohort, the sensitivity of PFUS in detecting UD was significantly higher than that of VCUG: 94% (IQR: 89-97) versus 78% (IQR: 73-85, p<0.01), with a trend toward higher specificity: 100% (IQR: 94-100) versus 84% (IQR: 78-84, p=0.05). Enabling direct UD visualisation, PFUS was associated with a positive predictive value (PPV) of 100% (IQR: 97-100) and a negative predictive value (NPV) of 88% (IQR: 78-95), whereas VCUG had an inferior accuracy with a PPV of 84 (IQR: 80-84) and a NPV of 68 (IQR: 62-79). In clinical practice, VCUG has a lower sensitivity than PFUS. Based on these results, we recommend the usage of dynamic PFUS as part of a non-invasive work-up.

Atypical presentation of recurrent female urethral diverticulum: A case report.

Introduction and importanceThe atypical urethral mucosal outpouching into adjacent tissue is termed urethral diverticulum (UD). Most patients present with a post-void dribble, dyspareunia, and dysuria.Case presentationWe reported a 60 years old woman who presented with recurrent urethral discharge, and a palpable lump in the vagina. Cystoscopy showed the location of the diverticular ostium.Clinical discussionUrethral diverticulum (UD) is uncommon and requires a relatively high level of suspicion, particularly in women with symptoms of atypical voiding. The widely-known classic symptoms involve the ‘three Ds’: post-void dribbling, dyspareunia, and dysuria. For radiological modalities, the transvaginal and transperineal ultrasound (US), Voiding cystourethrogram (VCUG), and cystoscopic examinations should be conducted to establish the diagnosis.ConclusionUrethral Diverticulum (UD) should always be considered in cases of urethral discharge and intravaginal mass. A complete history, complete clinical, VCUG, and cystoscopic examinations should be conducted to establish the diagnosis. The technique of three-layer vaginal flap is related to a very good success rate without major complications.

Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy.

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

Sarcomatoid urothelial carcinoma arising in the female urethral diverticulum.

A sarcomatoid variant of urothelial carcinoma in the female urethral diverticulum has not been reported previously. A 66-year-old woman suffering from dysuria presented with a huge urethral mass invading the urinary bladder and vagina. Histopathological examination of the resected specimen revealed predominantly undifferentiated pleomorphic sarcoma with sclerosis. Only a small portion of conventional urothelial carcinoma was identified around the urethral diverticulum, which contained glandular epithelium and villous adenoma. The patient showed rapid systemic recurrence and resistance to immune checkpoint inhibitor therapy despite high expression of programmed cell death ligand-1. We report the first case of urethral diverticular carcinoma with sarcomatoid features.

P0374 - The presentation, management and outcome of female urethral diverticulum surgery – A 2 centre 2 continent study

P0374 - The presentation, management and outcome of female urethral diverticulum surgery – A 2 centre 2 continent study

Correlation between symptoms and imaging findings including pelvic floor ultrasound to improve the symptom-based diagnosis of female urethral diverticulum (CHECK-UD study).

The objective was to establish a model to predict the presence of a female urethral diverticulum (UD) based on symptoms. A prospective CHECK-UD study (check of female urethral diverticulum) was conducted. Female patients presenting with symptoms such as lower urinary tract symptoms (LUTS), postmicturition dribble or urinary incontinence (UI), dyspareunia or pain in the pelvic area, and recurrent urinary tract infection (UTI) treated between 2015 and 2020 were included. The association between each symptom variable and the positive finding of UD was evaluated by multivariate logistic regression adjusting for age, body mass index (BMI), vaginal deliveries, previous surgery for SUI, previous pelvic surgery, and microscopic hematuria. A predictive model for the presence of UD was then created. In total, 189 female patients with a minimum of one symptom were enrolled. Pelvic floor ultrasound revealed the presence of UD in 66 out of 189 (34.92%). Of the four symptoms, the combinations "LUTS + postmicturition dribble + UTI," "postmicturition dribble + LUTS," and "UTI + LUTS" were most significantly related to positive findings and had a higher positive prognostic value for the diagnosis of UD than each individual symptom alone (OR = 13.78 [95% CI: 6.95-16.35], p < 0.001; OR = 9.94 [95% CI: 4.60-12.2], p < 0.05; and OR = 5.78 [95% CI: 1.58-6.98] p =0.05) respectively. Based on our model, the combination "LUTS + postmicturition dribble + UTI" seems to be the most sensitive combination of clinical symptoms predicting the positive finding of UD. This model could be used for patient counseling and for the identification of patients with UD.

Transvaginal surgical repair of large urethral diverticula with bipedicle double-opposing flaps of the periurethral fascia.

The aims of this study were to describe a novel technique for transvaginal repair of large (> 4cm) female urethral diverticulum (UD) using bipedicle double-opposing flaps of the periurethral fascia and to evaluate long-term follow-up. The medical records of 29 women who underwent transvaginal excision of UD at our institution were reviewed retrospectively. Seventeen cases with UD > 4cm were included in the study. Cystourethroscopy was performed at the beginning of the surgery, and in 60% of cases the orifice of the diverticulum was identified. An inverted-U incision was performed at the vaginal anterior wall. The periurethral fascia was incised longitudinal at the midline and parallel to the urethra. The diverticular sac was dissected and resected. The neck of the diverticulum was closed with 4/0 vicryl suture. The periurethral fascia was sutured using bipedicle double-opposing flaps with interrupted 3/0 vircyl suture. The vaginal mucosa was sutured with 2/0 vicryl continuous suture. All 17 women with large UD were operated on using bipedicle double-opposing flaps of the periurethral fascia. Follow-up of 5 ± 2.4years yielded no recurrence and no other late complications. Using bipedicle double-opposing flaps of the periurethral fascia during transvaginal excision of large UD is safe and effective.

Дивертикул уретры у женщины

Urethral diverticulum is one of the rarest female urological diseases, which is characterized by various manifestations, ranging from an asymptomatic to severe urinary disorders, pain and dyspareunia. The aim of this work is to present a clinical observation of female urethral diverticulum with a description and discussion of its etiology, diagnosis, and treatment. Clinical observation is dedicated to 40-year-old woman with complaints of pain in the urethral area. The patient underwent ureteral stenting followed by a diverticulectomy. Vaginal diverticulectomy is the gold standard for treatment. The specialist performing such interventions should be aware for possible intraoperative complications. It seems appropriate to perform the surgical treatment of female urethral diverticulum in specialized centers with an experience in female urethral reconstruction.

P-03-2 Female Urethral Diverticulum Presenting as Dyspareunia. A Case Report

P-03-2 Female Urethral Diverticulum Presenting as Dyspareunia. A Case Report

Case study: urethral diverticulum with calcifications in a premenopausal woman

Female urethral diverticulum is a fairly rare pathology, the frequency of which ranges from 0.02 to 6.00% of women worldwide. The stones inside urethra diverticulum even more rare. The most common reasons of urethral diverticula are frequent bladder catheterizations, labour trauma, infections. Clinically is may present with the dysuria, dyspareunia, dribble, urinary incontinence, vaginal discomfort. Voiding cystourethrography and cystourethroscopy are the most accurate methods of diagnosis for urethral diverticula. The presented article describes the clinical case in women with urethral diverticulum who complained on the vaginal discomfort, dyspareunia and presentation of the brown stones in vagina and underwent surgical excision of diverticulum with urethral reconstruction.

Analysis of female urethral diverticulum in foreign countries

Objective To improve clinical recognition of urethral diverticulum(UD) and avoid misdiagnosis for female. Methods All the literatures about female urethral diverticulum were retrieved from PubMed, during the past ten years. Bibliometric were used to collate the literature and evaluate the data. Results There were 37 related papers and 375 effective cases. The summary and analysis of the related symptoms and signs described by all the patients showed that the clinical manifestations of foreign patients were mostly dysuria and incontinence. The level of diagnosis and treatment of female urethral diverticulum in different countries of the world was not uniform. All the cases were treated with surgical resection of diverticulum, and there was no uniform surgical method, curative effect was available. Conclusions The incidence of female urethral diverticulum is controversial. Clinical manifestations are not specific, may be associated with calculi and urinary incontinence, and there may be cancer. It should improve the level of clinical diagnosis and treatment, the rate of missed diagnosis and misdiagnosis can be reduced. Key words: Urethral diverticula; Female; Dysuria; Urinary Incontinence

Letter to the editor re: Female Urethral Diverticulum with Large Calculus: Presentation and management, J Clin Urol, DOI:10.1177/2051415819854877

Letter to the editor re: Female Urethral Diverticulum with Large Calculus: Presentation and management, <i>J Clin Urol</i>, DOI:10.1177/2051415819854877

Female urethral diverticulum with large calculus: Presentation and management

Level of evidence: Not applicable for this multicentre audit

Diagnostic tools for female urethral diverticulum: Current perspectives

Although once considered quite a rare condition in the past, female urethral diverticulum (UD) would now appear to have a higher frequency, perhaps due to greater attention from physicians. To date, there is no agreement on which is the best method for diagnosis of female UD. Traditionally, the approach was based on quite invasive techniques, such as voiding cystourethrography, and double-balloon urethrography, with satisfactory results but relevant limitations. More recent high-resolution imaging techniques, such as 2D-3D ultrasonography (US) and magnetic resonance imaging (MRI) have also been applied in the study of the abnormalities of the female urethra. US had the advantage of the outpatient setting, non-invasiveness and absence of contrast medium use; MRI, is characterized by high sensitivity thanks to multiplanar capability, with an optimal characterization of periurethral diseases or its abnormalities, and lack of ionizing radiation. A real innovation is represented by computer tomography-voiding cystourethrography, a rapid technique that allows for high quality simultaneous 2D and 3D images of the urethra, well correlated to MRI and consequently with surgical results. Here, we report and comment the available tools in the diagnosis of female UD, focusing particularly on pros and contra of different methods.

"Horseshoe" sign in a female urethral diverticulum.

"Horseshoe" sign in a female urethral diverticulum.

Imaging Features and Complications of Female Urethral Diverticula

A female urethral diverticulum is a focal outpouching of the urethra into the urethrovaginal potential space.1 The reported incidence of urethral diverticula in women is approximately 1% to 6%, with the diagnosis typically occurring between the third and sixth decades of life.2 In symptomatic women, the classic clinical triad of dysuria, dyspareunia, and postvoid dribbling is present (the “three Ds”).1 However, women with urethral diverticula are more commonly asymptomatic or present with an array of nonspecific genitourinary symptoms such as urinary frequency and urgency, chronic or recurrent urinary tract infections, hematuria, and stress or urge incontinence. More atypical presentations include urinary retention, urethral pain, purulent urethral discharge, pelvic or suprapubic pain, or a tender mass.1 , 3 Because of the varied clinical presentation, a urethral diverticulum should be considered in all women with unexplained lower genitourinary tract symptoms.3 Other differential diagnoses for women presenting with unexplained lower genitourinary symptoms include interstitial cystitis, urethral syndrome (ie, urinary urgency and frequency with negative urine cultures); Skene's gland abscess; Gartner duct cyst; ectopic ureterocele; periurethral fibrosis; urethrocele; endometrioma; urethral or vaginal neoplasm; and collagen bulking agents used for the treatment of stress urinary incontinence.1 , 3 The correct diagnosis of a urethral diverticulum is critical, as potential complicating features include recurrent infection, calculus formation, and intradiverticular malignancy.2 Moreover, late diagnosis of urethral diverticulum is associated with high risk of postoperative complications, high recurrence rate after surgery, and, if malignancy is present, early metastases.1

Managing female urethral diverticulum with a standardized technique using a pacifier-trick artifice to facilitate dissection.

Managing urethral diverticula is challenging because of recurrence rate and postoperative complications. Herein, we report a standardized, single-institution experience of surgical treatment of urethral diverticula in women. The medical record of 37 female patients treated for urethral diverticula between 2005 and 2017 in a single institution were reviewed. All patients were operated in a standardized genupectoral position using a technical artifice called the pacifier trick to inflate diverticula throughout the procedure and facilitate its dissection. Symptoms at diagnosis, imaging findings, surgical parameters, postoperative complications, and recurrence rates were collected and are presented. Median age was 39 ± 11 (range 21-67) years. At diagnosis, recurrent urinary tract infections (UTI) (67%), vaginal mass (46%), pelvic pain (43%), dyspareunia (27%), and urinary incontinence (UI) (24%) were the most commonly reported symptoms. Median operative time was 98 ± 31 (range 40-150) min. After a mean follow-up of 1year, recurrence occurred in one (3%) patient. Immediate de novo postoperative UI decreased from 27% immediately after surgery to 3% after pelvic physical therapy. Pathological analyses found no malignant histology. Surgical management of urethral diverticula in women is technically demanding. With our standardized pacifier-trick technique, satisfying anatomical and functional results were achieved.

Management of Female Urethral Diverticulum

Management of Female Urethral Diverticulum