Urethral Diverticulum Research Articles

British Association of Urological Surgeons (BAUS) consensus document for the management of benign female urethral lesions.

To provide a consensus document for the management of benign female urethral lesions. The British Association of Urological Surgeons (BAUS) Female, Neurological and Urodynamic Urology (FNUU) Section created a consensus document to guide the management of the commonest of urethral swellings using expert consensus with a modified Delphi technique. Benign urethral lesions in females can include urethral mucosal prolapse, urethral caruncle, Skene's gland cysts and urethral diverticulum. They can present in a variety of ways including haematuria, lower urinary tract symptoms and voiding dysfunction, and can initially be overlooked or not recognised, resulting in delayed management. This consensus statement led by the FNUU Section of the BAUS, in consultation with BAUS members and consultants working in units throughout the UK, aimed to create a comprehensive and pragmatic management pathway for the assessment, investigation and treatment of benign urethral lesions in females.

Time to complication after primary pediatric hypospadias repair with transverse preputial island flap urethroplasty.

Hypospadias is one of the most common congenital malformations in men. The transverse preputial island urethroplasty is widely used in China, especially for moderate and severe cases due to its convenient prepuce of the penis. This analysis aims to delineate the time to first complication following transverse preputial island urethroplasty. We analyzed the clinical data and follow-up results of children who underwent hypospadias repair by transverse preputial island urethroplasty in Beijing Children's Hospital, Capital Medical University from December 2018 to December 2019 retrospectively. Postoperative complications included urethral fistula, urethral diverticulum, urethral stricture, persistent chordee. Univariate analysis of clinical variables and time to complication was performed using Kaplan-Meier survival curve. One hundred and sixty-five patients were identified. During the follow-up period, complications occurred in 101 cases (61.2%). Ninety-four percent of complications occurred within 1 year. Among children who experienced complications, Kaplan-Meier survival analysis showed that age less than 18 months and the severity of hypospadias were statistically significant (P=0.005 and P=0.04, respectively). The time to urethral diverticulum was significantly longer than that of urethral fistula and urethral stricture. More than 90% of complications after the transverse preputial island urethroplasty of hypospadias occurred within 1 year, with those related to proximal hypospadias presenting earlier than those of midshaft/distal hypospadias. Surgeons may consider a more frequent follow-up within the first year after surgery to detect these complications as early as possible.

I saw the “female prostate”

This article delves into the diagnostic implications of the female prostate sign, a distinctive radiological sign observed in magnetic resonance imaging of female patients with substantial urethral diverticula. We discuss the association of this sign with urethral diverticula, emphasizing its mimetic resemblance to prostatic hypertrophy observed in older males. Through a comprehensive review of clinical presentations, diagnostic imaging advancements, and treatment modalities, our article underscores the significance of magnetic resonance imaging as a superior diagnostic tool. Our findings support the enhanced recognition and understanding of the female prostate sign among healthcare professionals, facilitating accurate diagnoses and informed management of urethral diverticula.

Evaluation of postoperative complications of hypospadias using high-frequency ultrasound imaging

PurposeVarious complications following hypospadias surgery present distinct manifestations when examined with ultrasound. Utilizing high-frequency ultrasound, clinicians can promptly identify these complications and initiate appropriate treatment. The aim of this study is to catalogue the ultrasonographic presentations of various postoperative complications following hypospadias surgery, thereby providing a reference for ultrasonographic diagnosis.MethodsUltrasonic images of post-hypospadias surgery from October 1, 2015, to June 30, 2023, recorded at the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences, serve as the basis for this investigation. Drawing on patient clinical diagnoses, this study compiles and selects representative ultrasound images of diverse complications.ResultsThe study encompassed a total of 121 subjects; 26 demonstrated urethral stricture on ultrasonic images, two presented local urethral dilation, six showed intraurethral hair-like structures, 17 revealed intraurethral septum, two exhibited intraurethral fold, one had urethral calculus, one displayed urethral calcification, 12 indicated intraurethral urine accumulation, and two showed urethral diverticulum.ConclusionUltrasound examination is helpful for postoperative diagnosis following hypospadias, detecting complications such as urethral stricture, urethral hair growth, and urethral diverticulum, which can help doctors choose appropriate clinical treatment strategies.

Skene's glands and urethral diverticula: comparative insights from an anatomical and histological study

Skene's glands and urethral diverticula: comparative insights from an anatomical and histological study

Placement of an artificial urethral sphincter in 8 male dogs with urethral diverticulum.

Urethral diverticulum (UD) is a poorly defined anomaly consisting of an outpouching of the urethra. Management without surgical resection is not previously reported in dogs. Report the outcome of male dogs presented for urinary incontinence with UD treated with an artificial urethral sphincter (AUS). Eight client-owned dogs with UD treated with an AUS. Multicenter retrospective study. Medical records from male dogs with urinary incontinence were reviewed. diagnosis of a UD by retrograde cystourethrography, cystoscopy, abdominal ultrasonography or contrast computed tomodensitometry (CT) or a combination of these modalities, AUS placement, and at least 1 follow-up. Urinary continence score (UCS) was attributed retrospectively. Median UCS at presentation was 1/5. A contrast cystourethrogram was diagnostic in 8/8 dogs. All diverticula were saccular, and 7/8 were within the prostatic urethra and 1/8 extended up to the membranous urethra. A congenital origin was suspected in 7 dogs and acquired in 1. Concurrent anomalies included renal dysplasia or chronic pyelonephritis (n = 4), bilateral cryptorchidism (n = 3), and pelvic urinary bladder (n = 3). All dogs were poorly/moderately responsive to phenylpropanolamine. Artificial urethral sphincter placement resulted in improvement in continence in all dogs with a median UCS of 4/5 (5/5 in 2/8 dogs, 4/5 in 5/8 dogs, 3/5 in 1/8 dogs). Urethral diverticulum should be considered in male dogs with persistent urinary incontinence not responding to medical management. Artificial urethral sphincter placement is an effective therapeutic option that improved continence scores in all dogs.

Surgical Approach to Urethral Diverticulum and Urethrovaginal Fistula With Mesh Erosion

Introduction and hypothesisThis video illustrates a rare surgical case involving a urethral diverticulum, urethrovaginal fistula, and mesh erosion.MethodsWe present a 58-year-old patient attending a tertiary care center with a suspected urethrovaginal fistula. Her concerns included stress urinary incontinence (SUI), recurrent urinary tract infection, and vaginal pain. The surgical history was notable for the placement of two different mesh slings during the same procedure to treat SUI. Preoperative evaluation and findings are illustrated in detail. The video uses a high-definition surgical camera to emphasize the initial intraoperative evaluation with localization of the fistula and diverticulum. We then demonstrate the approach to the dissection with the goal of ensuring complete resection of the diverticulum, fistula, and mesh, while preserving healthy tissue for subsequent closure. The utilization of unique and specialized tools for each portion of the procedure is also illustrated. A layered vaginal closure, including a Martius flap, is created to prevent recurrence.ResultsThe surgery was accomplished without complications.ConclusionsTo our knowledge, concomitant findings of a urethral diverticulum, urethrovaginal fistula, and mesh erosion are unique in the literature. We postulate that this triad could have resulted from the mesh burden in this particular patient.

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)

Urodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Pelvic Organ Prolapse and Reconstructive Surgery (Including Non-trauma Related Fistula and Urethral Diverticulum) (PD24)

Evaluation and repair of a complex recurrent urethral diverticulum with calculus formation involving a sub-urethral incontinence sling: a case report

Evaluation and repair of a complex recurrent urethral diverticulum with calculus formation involving a sub-urethral incontinence sling: a case report

Case Report: Urethral Diverticulum after Distal Hypospadias Repair: An Uncommon Complication.

Abstract* Introduction A urethral diverticulum can be defined as a pocket that forms from the lining of the urethra and protrudes into the surrounding tissue, a condition which causes voiding dysfunction and may result as a rare complication of hypospadias repair surgery. Case report We report the case of a 2-year-old child who presented to us in 2019 complaining of a thin forceful stream, ballooning of the ventral aspect of the penis while voiding, and post-void dribbling. He has a history of undergoing a tabularised incised plate urethroplasty for distal penile hypospadias at 18-months-old. Ultrasound showed increased post-void residual volume and cystourethroscopy confirmed a urethral diverticulum extending from the subcorona to the base of the penis. The patient underwent partial excision of diverticulum, urethroplasty, and meatoplasty. He was followed-up 3 months later with complete resolution of his symptoms and a normal urinary stream with no urethral ballooning or dribbling. Conclusion Urethral diverticulum may present as a complication post hypospadias repair. Although it is rare, we believe that it is important for the patient’s parents to understand the possibility and know of the signs and symptoms in addition to attending regular outpatient clinic appointments in order to facilitate early management if needed. Furthermore, it is highly important for physicians to assess newborns for hypospadias before carrying out circumcision as it is a contraindication for the procedure.

Complete excision of a Skene gland cyst mimicking cystocele.

Skene gland abnormalities include skene gland cysts and abscess. These can be differentiated from urethral diverticulum based on clinical findings. The exact incidence of Skene gland abnormalities is unknown as they are relatively rare. They are usually seen in middle-aged female patients but have recently been reported in newborn girls. We present a video case of a large, adult-onset Skene gland cyst, which was evaluated based on clinical findings, radiological aspects and histopathological findings. The differential diagnosis was carried out step-by-step in order to avoid sequelae and complete excision was performed in order to achieve optimal results, both for long-term functional and anatomical outcomes.

Surgical correction of penile urethral diverticulum in a Jamunapari crossbred kid: A clinical case report

Surgical correction of penile urethral diverticulum in a Jamunapari crossbred kid: A clinical case report

A Large Anterior Urethral Calculus Presenting as Urethrocutaneous Fistula

Presentation of urinary calculus ranges from painful urination to acute retention. Diagnosed by x-ray pelvis and non-contrast CT and removal of stone by various methods is the management. Variety in symptoms, sometimes make clinical diagnosis difficult until radiological investigations confirm it. In this case presentation, initial diagnosis was made of Urethrocutaneous fistula may be due to distal stricture, but on investigating, he was diagnosed as urethral calculus in urethral diverticulum , as the reason for his symptoms

Симптомокомплекс дивертикула уретры у женщин.

Introduction. Urethral diverticulum in women is one of the rarest urological diseases, its frequency ranges from 0.02 to 6%. Urethral diverticulum clinically manifests itself in patients between the third and fourth decades of life and its diagnosis is often difficult because urethral diverticulum can mimic other pelvic floor diseases. Often, incorrect diagnosis leads to the prescription of erroneous treatment for recurrent urinary infection, overactive bladder, urinary incontinence, chronic pelvic pain, etc. The aim of this article is to determine the correlation between the topographic-anatomical parameters of the diverticulum, clinical manifestations and results of surgical treatment. Methods and materials. For the purposes of the study, 50 patients with urethral diverticulum were included in the study. All patients were examined and operated on at the Department of Urology of A.I. Yevdokimov Moscow State University of Medicine and Density, on the basis of the S.I. Spasokukotsky State Clinical Hospital in the 3rd and 4th urological departments in the period 2019 to 2022. The duration of postoperative follow–up is 2 years. The results of the study were statistically processed. Results. Most often, patients with urethral diverticulum experience the classic triad of symptoms: dysuria, dispareunia, dribbling, as well as symptoms associated with an infectious-inflammatory process in the bladder and urethra. Analysis of symptoms showed that their presence and severity do not correlate with the size of the diverticulum. A statistically significant relationship was revealed between the size of the urethral diverticulum and the presence of postoperative complications. The larger the diverticulum, the higher the chance of complications in the postoperative period. The location of the urethral diverticulum does not affect the development of complications in the postoperative period. Conclusions. Based on the results of the study and analysis of the data obtained, the dependence of the frequency of complications (periodic increase in body temperature, weak stream during urination and stress form of urinary incontinence) after diverticulectomy via vaginal access on the size of the urethral diverticulum can be traced.

Bladder outlet obstruction in women: Scope of the problem and differential diagnosis

AbstractIntroductionThe prevalence, formal definition, and diagnostic criteria of bladder outlet obstruction in owmen have not been clearly defined.MethodsThis is a literature review of the definition of BOO in women, its prevalence, as well as its differential diagnosis.ResultsThe main causes of BOO in women are divided into functional and anatomic conditions. Functional etiologies include detrusor external sphincter dyssynergia, dysfunctional voiding, Fowler's syndrome, and primary bladder neck obstruction. Anatomic causes can be further divided into extrinsinc and intrinsic conditions. Intrinsic etiologies include urethral stricture and urethral diverticula, whereas extrinsic causes comprise pelvic organ prolapse, post anti‐incontinence surgery, and Skene's gland cyst or abscess.ConclusionsThere are multiple etiologies to BOO in women, and this condition is most probably underdiagnosed, owing to a lack of consensus for a standard definition.

Gender-affirming care in urology: emergency care of the gender-affirming surgical patient-what the primary urologist needs to know.

To present a narrative review of fundamental information needed to manage postoperative complications in patients who have undergone genital gender-affirming surgery (GAS). A narrative review was performed using the following keywords: 'gender-affirming surgery', 'complications', 'emergency', 'postoperative'. Articles were included after being reviewed by two primary authors for relevance. Four clinicians with significant experience providing both primary and ongoing urological care to patients after GAS were involved in article selection and analysis. The most common feminising genital GAS performed is a vaginoplasty. The main post-surgical complications seen by urologists include wound healing complications, voiding dysfunction, postoperative bleeding, vaginal stenosis, acute vaginal prolapse and graft loss, rectovaginal fistula, and urethrovaginal fistula. The most common masculinising genital GAS options include metoidioplasty and phalloplasty. Complications for these surgeries include urethral strictures, urethral fistulae, and urethral diverticula. Penile implants may also accompany phalloplasties and their complications include infection, erosion, migration, and mechanical failure. Genital GAS is increasing, yet there are still many barriers that individuals face not only in accessing the surgeries, but in receiving follow-up care critical for optimal outcomes. Improved education and training programmes would be helpful to identify and manage postoperative complications. Broader cultural level changes are also important to ensure a safe, gender-inclusive environment for all patients.

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.

Laparoscopic-assisted anorectoplasty for anorectal malformation with rectobulbar fistula: A two-center comparative study with posterior sagittal anorectoplasty.

Due to the controversy on the feasibility of laparoscopic-assisted anorectoplasty (LAARP) for the treatment of the anorectal malformation (ARM) with rectobulbar fistula (RBF), this study aimed to compare the outcomes of LAARP and posterior sagittal anorectoplasty (PSARP) for ARM with RBF. Demographic data, postoperative complications, and bowel function of RBF patients who underwent LAARP and PSARP at 2 medical centers from 2016-2018 were retrospectively reviewed. Eighty-eight children with RBF were enrolled, including 43 in the LAARP group and 45 in the PSARP group. There were no significant differences in the sacral ratio (P = .222) or sacral agenesis (P = .374). Thirty-seven and 38 patients in the LAARP and PSARP groups were followed up for a median of 4.14 years. The postoperative complications were comparable between the groups (P = .624), with no cases of urethral diverticulum. The urination of all cases was normal and no evidence of cyst formation was found on MCU or MRI during the follow-up period. The incidence of rectal prolapse was similar between the 2 groups (9.3% vs 17.8%, P = .247). The groups had equivalent Bowel Function Score (15.29 ± 2.36 vs 15.58 ± 2.88, P = .645), but the LAARP group had better voluntary bowel movement (94.6% vs 84.2%, P = .148) by Krickenbeck classification. The intermediate-term outcomes of LAARP show that the urethral diverticulum was rare by the intraluminal incision of the fistular and the bowel function was comparable to that of PSARP in ARM with rectobulbar fistula. However, LAARP was associated with smaller perineal wounds.

Risk factors for postoperative complications following one-stage proximal hypospadias repair involving the disconnection of the urethral plate: a retrospective study

BackgroundChildren with hypospadias are at risk of serious physical and mental health problems, including abnormal urination, sexual dysfunction, and infertility. The sole available treatment is the surgical restoration of genital appearance and function. Proximal hypospadias (PH) correction is more challenging and carries a higher risk of complications than does distal hypospadias correction, with a higher likelihood of postoperative complications requiring additional surgery, resulting in considerable economic and psychological strain for families. Herein, we aimed to identify factors associated with complications following one-stage PH repair with urethral plate disconnection.MethodsWe retrospectively analyzed data from 236 children who underwent PH repair at our center between December 2020 and December 2022. We collected information on age, surgical procedure, length of the reconstructed urethra (LRU), glans width (GW), ventral curvature, surgical approach, preoperative androgen use, suture type, presence of prostatic utricle, body mass index, season of surgery, anesthesia type, low birth weight, preterm birth, follow-up period, and complications. Surgical complications included urethral fistulas, urethral diverticula, anastomotic strictures, urethral strictures, glans dehiscence, and penile curvature recurrences. The study population was divided into complication and no-complication groups, and univariate and multivariate analyses were conducted.ResultsOf the 236 patients with PH who had a median follow-up of 10.0 (8.0, 14.0) months, 79 were included (33.5%) in the complication group and 157 were included (66.5%) in the no-complication group. In the univariate analysis, age (P < 0.001), LRU (P < 0.001), degree of penile curvature (P = 0.049), and PH with prostatic utricle (P = 0.014) were significantly associated with complications after PH repair. In the multivariate logistic regression analysis, LRU (P<0.001, odds ratio [OR] = 3.396, 95% confidence interval [CI]: 2.229–5.174) and GW (P = 0.004, OR = 0.755, 95%CI: 0.625–0.912) were independent factors influencing postoperative complications. The optimal LRU threshold was 4.45 cm (area under the curve, 0.833; sensitivity, 0.873; specificity, 0.873; P<0.001, OR = 3.396, 95% CI: 2.229–5.174).ConclusionsLRU and GW are independent factors affecting PH complications. An LRU of < 4.45 cm and an increased GW can reduce the risk of complications.

Aspectos clínicos e cirúrgicos de hipospadia e divertículo uretal em caprinos

Hypospadia is the imperfect closure of the external urethra of the male which results from the incomplete fusion of the urogenital folds and abnormal openings of the penile urethra. The urethral diverticulum is the abnormal dilatation of the urethra, and can be of multifactorial origin and related to genetic, endocrinological and environmental factors. The objective of this article is to report on the clinical and surgical treatment of two cases of hypospadias and one case of urethral diverticulum in goats raised as pets, originated from cross breeding polled pairs. In Case 1 the hypospadias was characterized by two orifices on the ventral portion of the penis, separated by a 2 cm interruption of the urethra, and in Case 2 by an orifice on the ventral portion in the region of the urethra. In both cases there was an accumulation of urine in the middle ventral region of the foreskin, leading to distension of the skin. Both cases were successfully treated by urethrostomy and partial penectomy with fixation of the proximal urethral ostium to the skin. In Case 3, the animal was seen at ten days of age with presence of a diverticulum in the preputial region, however, the animal returned for new care only after four months due to urethral obstruction and died as a result of advanced azotemia. Surgical treatment of hypospadia, when performed before the development of azotemia associated with urinary retention, has been shown to be efficient, and post-operative care is important.