Urethral Diverticulum

Mainly present in females, urethral diverticulum is a pouch or cyst next to the urethral wall. It can also present itself as a pocket in the urethra herniating into the vaginal wall.

• An estimated one to six percent of women have this condition.
• Women between age 40 and 70 are the most prone to urethral diverticulum.

The exact cause of urethral diverticulum remains unclear. However, risk factors may include:

• Birth defect – Urethral diverticulum may be present at birth with an unknown percentage of women. However, it may not present itself as problematic until pregnancy or onset of other conditions.
• Glands next to the urethra may become inflamed.
• Vaginal birth and/or trauma to the vagina, often during birth, is cited as one of the most likely causes.
• Repeated urinary tract infections contribute to urethral diverticulum, and weaken the urethra, allowing herniation of the urethra muscoa or inner lining against the muscular structure of the outer walls of the urethra.

Some women have no noticeable symptoms. Most women, however, have a variety of symptoms associated with urethral diverticulum. These include the following:

• Dysuria – A burning sensation felt while urinating (this tends to be the most common symptom)
• Dyspareunia – Symptoms associated with pain experienced during intercourse
• Cystitis – Frequent infections of the urinary tract overall, not limited to the lower tract
• Post urination dribbling (present in up to 32 percent of women with urethral diverticulum)
• Mass in the vaginal area, or near it
• Blood in the urine, known as hematuria
• Incontinence associated with urination
• Vaginal discharge, and pus or urine that is pushed out through the urethra during physical examination when gentle pressure is applied
• Pain when urinating
• Pain during physical examination when gentle pressure is applied against the vaginal mass
• Obstruction of the urinary tract
• Bladder infections
• Inability to completely empty the bladder

Nearly all medical literature and experts agree that this condition is misdiagnosed or overlooked often. This may be because symptoms are similar in nature to more common conditions. However, advancement in imaging techniques have greatly increased the number of correct diagnoses. In addition to physical examination, other methods for diagnosis include imaging tests, urinalysis, cystoscopy, ultrasound, and urodynamic studies.

Typically, surgical removal of a urethral diverticulum through excisional surgery is necessary. Occasional transvaginal aspiration is done if the diverticulum infection has progressed into an abscess.