Female Urethral Diverticulum Research Articles

Safety and efficacy of transurethral diverticulum section for treatment of adult female urethral diverticulum

Objective To discuss the feasibility and the curative effect of transurethral diverticulum section in the treatment of female urethral diverticulum. Method We retrospectively analyzed the transurethral diverticulum section surgeries of 11 adult female patients diagnosed as urethral diverticulum in our hospital from August 2012 to October 2016.The patients aged from 33 years old to 74 years old with an average age of 43.Their medical histories varied from 1 month to more than 40 years with an average histories of 80 months. Major symptoms included odynuria, frequent micturition, dyspareunia, perineum bearing-down feeling, repetitive urinary tract infection, dysuria, urinary stuttering, penis masses, etc.One patient underwent TVT-O.Two patients had urinary catheterization before the disease.During physical examination, cystic masses of different sizes could be touched on anterior vaginal walls with pain and secretion.Cystic lesions can be found by imaging examination.Transurethral diverticulum section was performed under general anesthesia.Using needle electrode by resectoscope, we made an annular incision in the direction of the vertical axis of the urethra, from the beginning of diverticulum ostium. The diverticulum completely communicated with the urethra. In 11 patients of transurethral endoscopic, the urethral sphincter and the diverticulum wall appeared morphological integrity and no damage. There was no liquid drained to de vagina. There was no urethral sphincter injury and no urethral vaginal leakage. We observed the operation time, bleeding volume, diverticulum position, the number of diverticulum, urethral sphincter intraoperative. We also observed the postoperative symptoms, short-term and long-term complications. Result All surgeries went on well, in which urethral diverticula were fully opened. The operation time was 30-45 minutes, average 35 minutes. The amount of bleeding within 5 ml. 4 cases with multiple diverticulum, with 2 cases of diverticulum ostia were 2, 2 cases of diverticulum ostia were 3.The other 7 cases with single diverticulum, diverticulum ostium was 1.The catheters were removed 2 weeks after the surgery, after that all patients can urinate normally. The follow-up time was 5-55 months(mean, 24 months). All pre-surgical symptoms disappeared and no complication occurred, such as urethral stricture, urinary incontinence, urethro-vaginal fistula, etc. Conclusion Transurethral diverticulum section is a reliable treatment for female urethral diverticulum with positive curative effect and no obvious complication. Key words: Female; Urethral diverticulum; Transurethral

Ultrasonographic Features of Female Urethral Diverticula: A Retrospective Study of 25 Patients.

This article summarizes the ultrasonographic features of female urethral diverticula on biplane transrectal ultrasound (B-TRUS). A retrospective study was performed with 25 consecutive women who were diagnosed and treated as having urethral diverticulum (UD) between January 2012 and March 2016. All the patients were preoperatively evaluated using B-TRUS. The number, location, configuration, size, and type of the UD on B-TRUS were assessed. Twenty-eight diverticula were found on B-TRUS. Twenty-two patients had single diverticulum, whereas the other 3 had double diverticula. The locations included proximal (14%), mid (46%), and distal (40%) urethra. In transverse section, the configuration presented as round or oval (46%), and horseshoe-like or circumferential (54%). The maximal diameter of the 28 diverticula ranged from 3 to 48 mm. The types contained simple UD (36%) and complex UD (64%). Color blood flow signal could be detected in the septa, cystic wall, and solid mass, whereas negative in other areas inside the UD. Various sonographic characters of female UD could be observed during the evaluation, including single or multiple diverticula, different sites, diverse shapes, and septa, calculi, or neoplasm inside diverticulum, all of which could be clearly displayed on B-TRUS.

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Female urethral diverticulum containing a urothelial carcinoma.

Female urethral diverticulum containing a urothelial carcinoma.

Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery.

To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD). Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded. Outcomes after surgery were assessed using survival analysis. All statistical analyses were 2-sided and P values less than 0.05 were considered significant. Statistical analysis was done using SAS version 9.2 and JMP version 9.0 (SAS Institute Inc.). A total of 164 cases were identified. Median age at diagnosis was 46 years (range, 21-83). The most common presenting symptom was recurrent urinary tract infection (98, 59.8%), followed by urinary incontinence (81, 49.4%), dysuria (62, 37.8%), dyspareunia (37, 22.6%), and hematuria (15, 9.1%). Examination revealed vaginal mass in 55 (33.5%) of the women. A significant trend was noted toward an increase in use of both magnetic resonance imaging and computed tomography (P < 0.001) along with a progressive decrease in use of urethrogram (P < 0.001) for diagnosis of UD over the years. Among 114 women who underwent surgical treatment for UD, 14(12.3%) women presented with recurrent UD and the 5-year recurrence rate after surgery for UD was 23.4% (95% confidence interval, 13.9-37.0) and a reoperation rate of 17.0% (95% confidence interval, 8.8-30.2) at 5 years. Female UD is a rare and unique condition. Clinical presentation is usually nonspecific, and magnetic resonance imaging is commonly used for confirming the diagnosis. Recurrence is not uncommon, and repeat surgical intervention might be needed.

Preoperative 3D and 4D-CT imaging using 640-Multislice CT (640-MSCT) in diagnosis of female urethral diverticulum

ObjectiveTo determine the sensitivity and specificity of 640-Multislice CT (640-MSCT) in diagnosing the female UD.Materials and methodsWe investigated 16 patients with symptomatic UDs preoperatively in our hospital from August 2010 to March 2016. The patients’ average age was 38.8 years. All patients were performed 640-MSCT of pelvis; then, 3D and 4D images were reconstructed preoperatively.ResultsIn 3D and 4D-CT images, out of 16 patients, thirteen patients had one ostium, two had 2 ostia and one had 3 ostia. Out of those thirteen patients, eight patients’ ostia were located at 5 o’clock and five patients’ at 7 o’clock. Patients with 2 ostia location were at 5 and 6 o’clock and 5 and 7 o’clock, respectively. Patients with 3 ostia location were at 5, 6 and 7 o’clock. The mean distance from the bladder neck to the ostia was 22.5 mm. The shape of UD was out-pouching in 11 patients (68.8%), U-shaped in four patients (25.0%) and circumferential in 1 patient (6.2%). The CT findings were confirmed by surgical findings.Conclusions640-MSCT is a useful tool in identifying UD’s shape and ostium (including number, location) before operation. Preoperative 640-MSCT should be an adaptable modality for clinically suspected UD patients.Advances in knowledgeSeveral imaging methods have been used to diagnose female UD. 640-MSCT may be more suitable to diagnose it for its higher sensitivity and specificity in diagnosis of female UD, especially in identifying UD’s shape and number and location of ostium.

The Prostate in Female? Clear Cell Adenocarcinoma in a Female Urethral Diverticulum

Urethral diverticular clear cell adenocarcinoma in a female patient is extremely rare. This tumor sometimes displays a characteristic image on magnetic resonance imaging, surrounding the urethra like the prostate does in men. We report a patient with this tumor who underwent cystourethrectomy and ileal conduit diversion. We think that imaging studies could be useful to make the appropriate diagnosis.

Urethral diverticulectomy with Martius labial fat pad interposition improves symptom resolution and reduces recurrence.

To assess the presenting features and medium-term symptomatic outcomes in women having excision of urethral diverticulum with Martius labial fat pad (MLFP) interposition. We reviewed our prospective database of all female patients having excision of a symptomatic urethral diverticulum between 2007 and 2015. Data on demographics, presenting symptoms and clinical features were collected, as well as postoperative outcomes. In all, 70 women with a mean (range) age of 46.5 (24-77) years underwent excision of urethral diverticulum with MLFP interposition. The commonest presenting symptoms were a urethral mass (69%), urethral pain (61%), and dysuria (57%). Pre-existing stress urinary incontinence (SUI) was present in 41% (29) of the women. After surgery, at a mean (SD) of 18.9 (16.4) months follow-up (median 14 months), complete excision of urethral diverticulum was achieved in all the women, with resolution of urethral mass, dysuria and dyspareunia in all, and urethral pain in 81%. Immediately after surgery, 10 (24%) patients reported de novo SUI, which resolved with time and pelvic floor muscle training such that at 12 months only five (12%) reported continued SUI. There was one symptomatic diverticulum recurrence (1.4%). The commonest presenting symptom of a female urethral diverticulum is urethral pain followed by dysuria and dyspareunia. Surgical excision with MLFP interposition results in complete resolution of symptoms in most women. The incidence of persistent de novo SUI in an expert high-volume centre is 12%.

Female Urethral Diverticulum with Malignancy at Presentation

Female urethral diverticulum is a relatively uncommon disease with diverse presentations. Occasionally malignancy can develop within the diverticulum. Due to their concealed location they may go unnoticed, only to present at an advanced stage. We report our experience with a lady with adenocarcinoma within a urethral diverticulum at presentation. The imaging capabilities of magnetic resonance imaging in accurately determining the extent of disease are emphasised.

1108 Urodynamic findings of female urethral diverticulum

1108 Urodynamic findings of female urethral diverticulum

A rare case of giant primary calculus in female urethral diverticulum

The female urethral diverticulum is a rare clinical entity and presence of primary stone in the diverticulum makes it rarer. We are reporting a case of a 60 year old woman who has consulted for hard vaginal mass associated with repeated urinary infections. The diverticulum was excised transvaginally along with extraction of giant stone of 3.5 cm, successfully .

Female Urethral Diverticulum: Current Diagnosis and Management.

While urethral diverticulum (UD) affects less than 20 per 1,000,000 women overall, it is thought to represent 1.4% of women with incontinence presenting to urology practices. It is hypothesized to evolve from periurethral glands that become obstructed, infected, and dilated over time, and patients typically present with dyspareunia, bothersome lower urinary tract symptoms (LUTS), and/or recurrent UTIs. In many patients, a periurethral mass can be appreciated on exam. In recent years, magnetic resonance imaging (MRI) has become the imaging test of choice for diagnosis of UD, but ultrasound (US) is a readily available alternative and provides good specificity at a lower cost. Surgical excision of the diverticulum with tension-free, water-tight, three-layer closure continues to be the mainstay of treatment of UD with most studies reporting cure rates of >90%. Concomitant treatment of preexisting stress incontinence with autologous fascial pubovaginal sling can be used at the time of diverticulectomy to avoid a secondary procedure. However, since secondary anti-incontinence procedures are needed in only a small number of patients, up-front stress incontinence treatment may result in significant overtreatment, and staged anti-incontinence procedures continue to be a reasonable option for patients with persistent bothersome stress urinary incontinence (SUI) after diverticulectomy.

Divertículos da uretra feminina: uma revisão contemporânea

IntroductionUrethral diverticula affect from 0.6 to 4.7% of women, are a frequent cause of persistent urinary symptoms and can present with complications such as lithiasis and malignization. Today, underdiagnosis and diagnostic and therapeutic delay of female urethral diverticula are still common. The aim of this article is to analyse the state of art regarding ethiology, diagnosis and therapeutics of this disease. Materials and methodsBibliographic revision of articles published until January/2014 after search of the database Medline for the keywords: “female urethral diverticula”, “female urethral diverticulum”, “urethral diverticula”, “urethral diverticulum” and “female urethra”; and of bibliographic references of the articles obtained. ResultsMost female urethral diverticula are secondary to infection of the periurethral and urethral glands. Despite the classically described triad of dysuria, dyspareunia and post‐void dribbling, the clinical manifestations are diverse and unspecific. Over a third are palpable on gynaecologic examination. Imaging exams, namely magnetic resonance and ultrasound, have high diagnostic capability and contribute to surgical planning. Depending on location, conformation and associated symptoms, urethral diverticula can be managed conservatively or, more frequently, surgically. DiscussionClinical evaluation is still essential for the diagnosis of female urethral diverticula. Currently, magnetic resonance is considered to be the best modality to diagnose the diverticula and to exclude pre‐ and post‐operative complications. Less invasive techniques have been described but transvaginal urethral diverticulectomy yields the highest symptomatic cure rates. ConclusionAwareness of the medical community is the most powerful weapon to reduce the underdiagnosis and diagnostic delay associated with female urethral diverticula.

Female Urethral Diverticulum: Diagnosis, Treatment and Outcome

Objectives: To share our experience regarding the handling of symptomatic or asymptomatic female urethral diverticula. Clinical presentation, diagnostic methods, and therapeutic strategies are reviewed. Methods: This was a retrospective analysis involving eight female patients with urethral diverticula who were followed up in our urology department between 2007 and 2015. Preoperative assessment included clinical examination and cystoscopy, voiding cystourethrogram, or magnetic resonance imaging. Postoperative follow-up visits were scheduled at 3, 6, and 12 months. Results: Diagnosis was based on anamnesis and physical examination, and then confirmed by complimentary exams such as voiding cystourethrogram and magnetic resonance imaging. All patients experienced symptomatic relief and improved esthetic outcome after surgery. Magnetic resonance imaging was instrumental in confirming the diagnosis and in planning the surgical approach. Surgical excision of the diverticulum and reconstruction resulted in good aesthetic and functional outcomes. There were no major postoperative complications. Conclusions: Previously unrecognized female urethral diverticula can now be more easily detected using magnetic resonance imaging. In our small series, surgical excision and reconstruction was associated with good clinical outcome.

Female urethral diverticulum: cases report and literature

IntroductionA female urethral diverticulum is an uncommon pathologic entity. It can manifest with a variety of symptoms involving the lower urinary tract. Our objective is to describe the various aspects of the diverticulum of the female urethra such as etiology, diagnosis and treatment.Cases presentationWe report five female patients, without prior medical history. They had different symptoms: dysuria in four cases, recurrent urinary tract infection in three cases, stress incontinence in two cases and hematuria in two cases. All patients had dyspareunia. The physical exams found renitent mass located in the endovaginal side of urethra which drained pus in two cases. Urethrocystography found a diverticulum of urethra in all cases. Our five patients underwent diverticulotomy by endovaginal approach. The course after surgical treatment was favorable. The urinary catheter was withdrawn after ten days. Some recurrent symptoms were reported.ConclusionEvaluation of recurrent urinary complaints in young women can lead to the finding of a diverticulum of urethra. Urethrocystography can reveal this entity. Diverticulectomy by endovaginal approach is the best choice for treatment.

Urethral Diverticulum in Young Nulliparous with Unusual Presentation.

We highlight a case of chronic skenitis leading to the formation of Urethral diverticulum. A young nulliparous woman presented with dysuria, intermittent hematuria and a 3 cm cystic swelling adjacent to the left distal urethra. Aspiration of the cyst was done initially. Excisional biopsy was followed when it recurred. Urethral diverticulum was revealed when the excisional operation traced up to left distal urethral wall. The cystic swelling urethral diverticulum was completely enucleated. The pathology report showed fibrous tissue with cystic spaces lined by squamous epithelium with inflammation, which was consistent with a urethral diverticulum. The presenting symptoms and signs of female urethral diverticulum are often diverse and easily overlooked, we have to keep in mind that cases with unusual age, location and presentation can also exist.

Resection of Urethral Diverticulum in Pregnancy

Female urethral diverticulum is a rare finding, less often diagnosed during pregnancy. There are few reports in the literature on urethral diverticulum in pregnancy with most undergoing expectant management. A young woman presented during the third trimester of pregnancy with pelvic and vaginal pain and a vaginal bulge. On examination, she was noted to have a 5-cm periurethral mass consistent with a urethral diverticulum. We describe the successful excision of this diverticulum during pregnancy. The procedure was performed without adverse consequences to the pregnancy, and the patient had a normal course for the remainder of her pregnancy and an uneventful cesarean delivery.

Incidence of female urethral diverticulum: a population-based analysis and literature review

Urethral diverticulum (UD) is a protrusion of the urethra through the periurethral fascia. We aimed to determine the population-based incidence of female UD. Using the records-linkage system of the Rochester Epidemiology Project (REP), we identified women 18 years and older with a new diagnosis of UD in Olmsted County, Minnesota, USA, from 1 January 1980, through 31 December 2011. We also identified cases meeting the same criteria diagnosed at Mayo Clinic, regardless of county of residency. Incidence rates were calculated and trends for changes in incidence over time were tested. We conducted a systematic search of the MEDLINE, EMBASE, Cochrane Systematic Reviews, CENTRAL, Web of Science, and Scopus databases from inception through 30 March 2013, to identify published reports of UD incidence or prevalence. We identified 164 incidence cases, including 26 women residing in Olmsted County. Age-adjusted annual incidence of UD in Olmsted County was 17.9 per 1,000,000 women (<0.02 %) per year (95 % CI, 10.9-24.9). We observed a trend toward increased incidence during the past 3 decades (P = 0.03). In our literature review, only 7 studies included an estimate of incidence or prevalence of UD; these estimates ranged from 6.4 per 1,000,000 per year (<0.01 %) having surgical intervention related to UD to a 4.7 % rate of UD diagnosed in asymptomatic women admitted for gynecological or obstetric issues. In this population-based study, female UD was a rare disease, affecting fewer than 20 per 1,000,000 women (<0.02 %) per year.

Diagnosis of female urethral diverticulum using transvaginal contrast-enhanced sonourethrography

This study investigated the value of transvaginal contrast-enhanced sonourethrography for the diagnosis of female urethral diverticulum (UD) by comparing results of contrast-enhanced ultrasound images and surgical findings. A total of 14 female UD patients underwent preoperative transvaginal contrast-enhanced sonourethrography between July 2010 and June 2012. History and physical examination were initially assessed by the same urologist. Transvaginal contrast-enhanced ultrasound imaging was performed and interpreted by the same ultrasonographer. Definite diagnosis was made by tracking the flow of the microbubbles into the cyst. Additionally, sagittal, cross-sectional, and dynamic images were obtained, and color Doppler ultrasound was applied in all cases. Data on the size, location, configuration, and opening of the UD was documented, and then compared with the surgical findings. The most common symptoms presenting in the UD patients included urinary incontinence (71.5 %), recurrent urinary tract infection (57.1 %), frequency (50 %), urgency (35.7 %), dysuria (35.7 %), and dyspareunia (21.4 %). On physical examination, 8 out of 14 patients (57.1 %) had a palpable anterior vaginal wall mass, while 6 out of 14 patients (42.9 %) had no palpable mass. Transvaginal contrast-enhanced sonourethrography revealed 17 diverticula orifices in total and correlated well with surgical findings regarding the size, location, configuration, and the opening of the UD. In patients with chronic irritative bladder symptoms, but with no response to conventional treatment a high index of suspicion for UD should be maintained. Our study demonstrates that transvaginal contrast-enhanced sonourethrography is a useful tool for defining the size, location, configuration, and opening of the UD before surgery.

Primary Clear Cell Adenocarcinoma in a Female Urethral Diverticulum: A Case Report and Review

Clear Cell Adenocarcinoma is a very rare variant of lower urinary tract malignancy. We present a 54 years old lady who presented with haematuria and a urethral mass on ultrasound. MRI subsequently demonstrated a heterogeneous mass within a urethral diverticulum. Biopsies of the mass demonstrated clear cell adenocarcinoma with clearing of the cytoplasm, moderate nuclear pleomorphism. Immunohistochemically cells were positive for: cytokeratin 7 and p16, p53, CA125, CAM5.2, AE1/AE3. They were negative for: thrombomodulin, oestrogen, progesterone, cytokeratin 20, p63, CD10, CEAP, WT1, AFP, s100. She underwent anterior exenteration with pelvic lymphadenectomy, and ileal conduit formation. Histology of which demonstrated surgically clear margins but 3/6 positive lymph nodes. She underwent 50.4Gy for consolidative radiotherapy given the lack of known benefit for chemotherapy. Subsequent PET scans have demonstrated lymphatic disease progression, but remains alive one year after diagnosis. doi: http://dx.doi.org/10.4021/wjnu67w