Male Urethral Diverticulum Research Articles

Urethral diverticulum with urethrocutaneous fistula and giant stone: A case report

Male urethral diverticulum is rare and usually associated with urethral obstruction. We report a 62-year-old male presented to emergency room with giant stone coming from scrotum without urinary retention. From clinical findings, a giant stone obviously burst out from his scrotal fistula. Pelvic computed tomography confirmed urethral diverticulum containing a giant stone with multiple smaller stones. Cystourethroscopy was performed to assess diverticulum and luminal obstruction, and no obstruction was found. We performed stones extirpation, diverticulectomy, and urethroplasty consecutively. Intraoperative findings confirmed preoperative detection. Complete stone-free rate and diverticulum removal were successfully accomplished. The patient was discharged postoperatively at day 7.

Symptomatic Male Urethral Diverticula- Presentation, Diagnosis and Management.

ABSTRACTObjective- To report our experience of aetiology, diagnosis, management and outcomes of uncommon male urethral diverticula managed at a single institute.Patients and Methods: After due approval from local ethical committee the case records of 8 male patients including a child presenting with urethral diverticula in a 10 year period (2002-2012) were retrospectively analysed with regard to presentation, diagnosis, management and outcomes.Results: A total of eight patients were identified having been managed for a urethral diverticulum during the period. Of the eight patients one was congenital diverticulum and rest acquired. A child aged 10 years, presented with straining to void and inability to empty the bladder and was diagnosed to have anterior urethral valve located at peno-scrotal junction. The valves were endoscopically resected and diverticulum de-roofed. The child recovered with good outcome of good flow and emptying of bladder. Patients with acquired diverticula, presented at a mean age of 42 years (25-60 years). The presentation was similar with two patients presenting with acute retention. The Aetiological factors included Trauma, Previous urethral surgeries like Visual internal urethrotomy and infection. The common site of diverticula was peno-scrotal junction, followed by distal penile urethra. Two patients were treated with primary excision and establishment of urethral continuity and rest with two stage procedures. The outcome was poor in one patient of primary excision who presented later with stricture at the anastamotic site.Conclusions: Unlike in female population, male urethral diverticula are uncommon but should always be thought of in young men with obstructive urinary symptoms and in those with a past history straddle injuries. Treatment if individualized leads to good outcomes.

A rare case of male congenital urethral diverticulum

Urethral diverticulum is a rare disorder in males. It may be the reason for constant dribbling and recurrent urinary tract infections in a male child. Early diagnosis and prompt management are essential to avoid urinary tract complications. This is a case report of a urethral diverticulum in an 8-year-old boy who presented with constant dribbling of urine.

Male urethral diverticulum uncommon entity: Our experience

Out pouching of the urethral wall could be congenital or acquired. Male urethral diverticulum (UD) is a rare entity. We present 2 cases of acquired and 1 case of congenital male UD. Case 1A: 40 year male presented with SPC and dribbling urine. Clinically he had hard perineal swelling. RGU revealed large diverticulum in proximal bulbar, irregular narrow distal urethra and stricture just beyond diverticulum. Managed with perineal exploration, stone removal, diverticulum repair and urethroplasty using excess diverticular wall. Case 2A: 30 year male with obstructive lower urinary tract symptoms (LUTS). Retrograde urethrogram (RGU) revealed bulbar urethral diverticulum akin to anterior urethral valve, managed endoscopically. 1 year follow up urine stream satisfactory. Case 3A: 27 year male previously operated large proximal bulbar urethral stone with incontinence. RGU large proximal bulbar UD with wide open sphincter. Treated with excision of excess diverticular wall and penile clamp with pelvic exercises for incontinence. Congenital UD develops due to imperfect closure of urethral fold, Acquired UDs occurs secondary to stricture, infection, trauma, long standing impacted urethral stones or scrotal / skin flap urethroplasties. RGU and MCU are the best diagnostic technique to confirm and characterize the UD. Urethral diverticulectomy with urethral reconstruction is the recommended treatment for UD. UD is a rare entity. Especially in males, congenital are even more rare. Management should be individualized. Surgery can involve innovation and/or surgical modifications. We used excess diverticular flap for stricture urethroplasty in one case.

Acquired male urethral diverticulum: Report of two cases

Urethral diverticulum (UD) was first described by Hey in 1805. Two third of UD are acquired and up to a third may be congenital. While UD are more common in women secondary to poor anatomical support of the urethra, it is rarely seen in men. Acquired UD in men may be seen after urethroplasty, after hypospadias repair when flaps are used. We report two cases of acquired UD in male children secondary to catheterization and after hypospadias surgery respectively.

Primary squamous cell carcinoma of the urethral diverticulum mimicking prostate cancer: Case report and review of the literature.

Primary urethral carcinomas are uncommon, with urothelial carcinoma as the most common subtype. Urethral diverticulum is also rarely seen in men. A 44-year-old male presented with voiding symptoms. Abdominoperineal resection, prostatectomy, bladder neck excision, and proximal urethral excision were performed. A pathological examination revealed a well-differentiated squamous cell carcinoma (SCC) located inside an urethral diverticulum. We report this unusual case because primary SCC of the male urethral diverticulum is extremely rare. To our knowledge, our patient is only the second reported case.

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.

Urethral diverticulum presenting as a scrotal mass in a paraplegic male: Report of a case and review of the literature

Male urethral diverticula are rare and can be congenital or acquired. We report a case of acquired urethral diverticulum presenting as a scrotal mass in a paraplegic male. On physical examination, the scrotal mass mimicked a primary intrascrotal lesion. However, on retrograde urethrography, the correct diagnosis was made. The patient had a small incontinent spastic bladder with a history of prolonged catheterization. Eventually, the urethral diverticulum was excised including the affected segment of bulbous urethra. Pathologic examination revealed the diverticulum wall lined by granulation and chronic inflammatory tissue.

Surgical Reconstruction of the Male Urethral Diverticulum

To describe the outcomes and reconstructive techniques used for men with symptomatic urethral diverticula in an attempt to standardize treatment based on the length of the urethral defect after diverticulum excision and the type of repair used. Urethral diverticula are rare in men and may be either congenital or acquired. Between 2003 and 2008, 13 men were treated surgically for symptomatic urethral diverticula at a single institution by a single surgeon (C.M.G.). A total of 6 (46.2%) patients had urethral defects of < 4 cm and underwent excision of the diverticulum with primary anastomosis. Substitution urethroplasty using either penile skin or buccal mucosa was used in 7 (53.8%) patients with urethral defects of >or= 4 cm. Demographic and preoperative characteristics were compared among patients according to the length of the urethral defect. The mean age of men at the time of surgery was 38.4 years (+/- 13.0; range, 20.4-63.7), with a median follow-up time of 21.7 (+/- 29.0; range, 0.9-84.0) months. Neither age at the time of surgery, length of follow-up, or diverticulum volume was significantly different between men who underwent primary repair vs substitution urethroplasty. The overall success rate was 92% (12/13) with an overall complication rate of 42% at intermediate follow-up. Outcomes after excision and primary anastomosis for diverticula associated with defects of < 4 cm were similar to outcomes after diverticulum excision and substitution urethroplasty for defect of >or= 4 cm.

Acquired male urethral diverticulum: case reports

Urethral diverticulum is a localised out pouching or fusiform dilatation of the urethra. It is an uncommon clinical entity affecting both males and females. Although, the diagnosis could be straightforward in the males, it may present as a diagnostic puzzle in the female because it often presents with non-specific symptomatology and diagnosis may not be easily made with common investigation techniques. Two cases of urethral diverticulum are presented to highlight the aetiopathogenesis of urethral diverticulum.

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.

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.

Stress urinary incontinence as the presenting symptom of primary male urethral diverticulum—A case report and literature review

Primary male urethral diverticulum is quite uncommon. It is even more unusual for urinary incontinence to be a presenting symptom of primary male urethral diverticulum. Herein, we report on a 32-year-old male presenting with urine leakage on coughing or abdominal strain beginning from his early twenties. A congenital type bulbar urethral diverticulum is diagnosed by voiding cystourethrography and cystourethroscopy. Endoscopic unroofing of the diverticulum freed the patient from stress urinary incontinence after the surgery.

Squamous cell carcinoma in a male urethral diverticulum

Squamous cell carcinoma in a male urethral diverticulum

Giant Urethral Diverticulum in an Adult Male: A Complication of the Artificial Urinary Sphincter

Urethral diverticulum in the male is a rare entity that may be congenital or acquired. An acquired diverticulum usually results from infection, urethral stricture or trauma.1 Patients typically present with symptoms of urinary incontinence, dysuria, perineal pain, or a mass on the ventral aspect of the genitalia or perineum. We report a case of a large male urethral diverticulum occurring after placement of an artificial urinary sphincter (AUS). CASE REPORT A 70-year-old male underwent radical retropubic prostatectomy for adenocarcinoma of the prostate in 1997. Postoperatively, incontinence and erectile dysfunction developed, and in 1999 the patient underwent placement of an inflatable penile prosthesis and AUS. During the following 2 to 3 years he experienced progressive left scrotal swelling, intermittent dysuria, recurrent urinary tract infections and microhematuria. He was treated with long-term antibiotic therapy. Ultimately, radiographic evaluation demonstrated urethral extravasation with associated urinoma. The AUS was removed and the urinoma drained. A urethral catheter was left indwelling. He was subsequently evaluated after the catheter had been indwelling for 3 months. A repeat retrograde urethrogram at that time revealed persistent extravasation of contrast material from the bulbous urethra. Physical examination showed passage of urine from the meatus around the urethral catheter with palpation of the visibly enlarged scrotum. Voiding cystourethrogram (VCUG) demonstrated a large urethral diverticulum filling the scrotum during the voiding phase (fig. 1). Flexible cystoscopy confirmed an opening within the mid bulbous urethra leading into an extensive smooth walled diverticulum. The patient underwent surgical exploration in the exaggerated lithotomy position. An 18Fr soft silicone catheter was placed through the urethra and into the bladder. A midline perineal and scrotal incision was made. The large diverticulum was identified and dissected from the surrounding tissues. After it was free ventrally and laterally the diverticulum was opened to expose better its communication with the urethra (fig. 2). After complete resection of the diverticulum the urethra was closed with interrupted 4-zero polydioxanone sutures. The operative wound was then closed in layers and drained. VCUG 2 weeks postoperatively revealed a nicely patent urethra without extravasation. The patient was to be considered for a repeat AUS after approximately 6 months.

Diverticules de l’urètre chez l’homme après urétroplastie : à propos de 4 cas

The author reports a serie of 4 cases of male urethral diverticulum. All cases were acquired origin. They are complication of urethroplasty. Diagnosis is clinical, based on the development of a perineal mass or phlegmon. This diagnosis is confirmed by cystourethrography. Treatment is by open surgery and consists on diverticulectomy and repair urethra in one stage. Two steps are necessary as the reported cases, where they are urethral stenosis or a inflammatory involvement of the peridiverticulum tissues. This treatment achieves good results.

2 cases of male urethral diverticulum combined with stone

Male urethral diverticulum is uncommon lesion, furthermore calculus formation within the male urethral diverticulum is very rare. Generally, urethral diverticula are classified as congenital and acquired. The majority of male urethral diverticula are acquired and approximately 10 to 20 per cent are congenital. Acquired urethral diverticula in the male may arise from many sources, including infection(prostatic abscess, infection of periurethral glands, hematoma or schistosomiasis), obstruction (stricutre, impacted stone, Cunningham clamp or condom catheter) and trauma(instrumentation, external injury and pelvic fracture). Calculi formation is more common in the acquired diverticulum owing to stagnation of urine and infection. These calculi in the diverticulum usually are solitary and may attain considerable size with predisposing factors. 1) a ureteral or bladder calculus that is lodged in the urethra, 2) urethral trauma or stricture, 3) calcification around a foreign body or hair. The treatment of urethral diverticulum conbined with stone is excision of the diverticula with removal of stone. We treated two cases of urethral diverticulum combined with stone in the male, and report with review of literature.

Acquired Male Urethral Diverticulum

Four cases of acquired urethral diverticula in male subjects are reviewed. All patients presented with complications such as urinary tract infection, urethral fistulas and stone or sequestrum formation in the diverticulum. The recommended treatment is excision of the diverticulum and repair of the urethra. The relevant literature has been reviewed.