An Overview of Urethral Diverticulum

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Your urethra is a tube through which urine from your bladder flows through to leave the body when you urinate. A urethral diverticulum (UD) is a pocket or pouch that forms along the length of your urethra. This pocket, because of where it's positioned, gets continuously filled with urine when you urinate, and this sometimes leads to pain, problems urinating, frequent infections, and urinary incontinence. The body parts urethral diverticulum affects are limited to the urethra, vagina, and pelvic area.

Although rare, urethral diverticulum can also lead to the formation of urethral calculus, a hard stone formed in the urethra as a result of the build-up of stagnant urine and salt deposits in the diverticulum.

Notwithstanding the fact that the number of diagnoses for it is rising, urethral diverticulum is generally not a common condition. The medical community speculates that its increasing prevalence is simply because of the existence of more sophisticated imaging techniques leading to more diagnoses than in the past. Urethral diverticulum is generally more common in women than men.

Symptoms

The symptoms of urethral diverticulum are varied, and their presence and severity are usually unrelated to the size if the pouch/sac. Indeed, you may have a urethral diverticulum and be asymptomatic (not experience any symptoms).

Some of the common symptoms of this condtion are:

You may only experience some but not all of these symptoms. In addition, they may not be constant—they may disappear for long periods of time only to return later on.

How a Urinary Tract Infection Is Treated

Causes

You may be born with a urethral diverticular or you may acquire one. Congenital urethral diverticulum (present from birth) usually stems from Gartner duct cysts and Müllerian duct cysts. The cause of acquired urethral diverticula isn't always known but it has been linked to obstruction of the urethral glands and multiple bladder infections that are thought to weaken the walls of the urethra. Trauma during a vaginal birth has also been identified as a contributor to the formation of urethral diverticulum.

Diagnosis

The symptoms of urethral diverticulum are not specific—it shares the symptoms of many other bladder or urethra related conditions. Some people are misdiagnosed and treated for other conditions like cystitis and vulvodynia for many years. It’s also sometimes diagnosed completely by accident, like when imaging tests for entirely different reasons are carried out.
The most reliable ways urethral diverticulum can be diagnosed by your doctor are:

  • Physical examination: In women, the walls of the vagina can be examined and felt for tender masses or areas. Also, your doctor may try to express pus or urine from the urethral diverticulum space.
  • Ultrasonography: This method will involve using ultra (high frequency) sound waves to obtain pictures of your urethra. It is one of the more common methods of diagnosis.
  • Cystoscopy: A cystoscopy is an in-office procedure that will involve inserting a cystoscope into your bladder to try and get a visual of if a urethral diverticulum exists.
  • Magnetic resonance imaging (MRI): MRI uses radio waves and a magnetic field to produce super clear images of the body. In this case, it will be used to get clear and precise images of your pelvic area and vagina to detect if there’s a mass present. Currently, this is accepted as the best test to diagnose urethral diverticulum.
  • Voiding cystourethrogram (VCUG): This involves an X-ray of your bladder and urinary tract taken while you are urinating.
  • Double-balloon positive-pressure urethrography (PPU): This particular method of diagnosis is somewhat similar to VCUG but it uses a special type of catheter with balloons. It is reportedly 90 percent accurate in detecting urethral diverticula. Because it is a more invasive and uncomfortable diagnostic method requiring anesthesia, it is not commonly used, especially not as a first diagnostic tool choice.

    Treatment

    Surgical excision is the main way to treat urethral diverticulum.

    Because of its highly technical nature, if you choose to have surgery, it will have to be performed by a specialized and experienced urologist. The experience and skill of the urologist are particularly important, as a badly done surgery can seriously worsen your condition and its symptoms.

    The surgical options you have include:

    • A complete removal or the pocket/sac. This is the most likely route your doctor will recommend.
    • Cutting into the neck of the pocket/sac and draining its contents completely.
    • Spence Procedure, which involves making an opening of the urethral diverticulum into the vagina. That is, an opening will be made for the contents of the sac/pocket to be able to flow out through the vagina.

    Any infection you may have must first be resolved before surgery can be performed.

    The surgical option chosen depends on the size and location of the urethral diverticulum, as well as other factors identified by your doctor. During your surgery, your urologist may also be to fix any incontinence issues you may have been experiencing. After surgery, you’ll likely be given some antibiotics for at least 24 hours to prevent infections. You may also be fitted with a catheter that’ll remain in place for some weeks for better healing. You’ll be instructed to show up for follow-up tests in subsequent weeks to check the success of the surgery, the status of your healing, and to remove the catheter.

    There are some side effects you risk from having any of these surgical procedures, such as serious bleeding, recurrence of the urethral diverticulum, infection, urethrovaginal fistula, and urethral scarring. You should discuss all of these with your doctor before consenting to the surgery.

    Alternatively, you may want to wait to see if your symptoms get worse or the urethral diverticulum gets bigger before considering surgery. It is also possible that you don't want to undergo surgery at all. In that case, your doctor will help devise a management plan with you. However, you should know that, as it stands, not much is known about leaving urethral diverticulum untreated—there’s no way to know if the pockets will get bigger or if your symptoms will worsen.

    You should also know that, although it’s very rare, there have been cases of people with urethral diverticulum developing carcinoma (a type of cancer).

    Coping

    If you have decided not have surgery to treat your urethral diverticulum, you should expect for your urologist to continuously monitor it. You will also need to adopt some measures to manage and cope with your symptoms (if you have any). For example, you may have to:

    • Take antibiotics regularly to deal with recurring UTIs
    • Take pain medication to help with pelvic pain and any other kind of pain you may be experiencing
    • Take anticholinergic drugs to deal with symptoms of an overactive bladder like frequent and urgent urination

    You should consider attending counseling sessions to help you deal with the condition better.

    If you elect to have surgery, you can expect to have a catheter in your bladder for at least two to three weeks. Your doctor should instruct you on self-catheterization or the proper methods to manage and keep clean the one already put in place. During your recovery post-surgery, you may experience bladder spasms. If you do, be sure to mention this to your doctor, as it can be managed by medication.

    A Word From Verywell

    If you've been diagnosed with urethral diverticulum, it is important that you discuss your options extensively with your doctor. You do not have to go through with having surgery if you don’t want to and your doctor agrees that it is not medically necessary.

    If you have opted to have surgery, it is natural for you to feel anxious or worried about the procedure and the possible outcomes. Your doctor should give you the details of what you should expect before, during, and after the surgery. It is advisable that you have positive yet realistic expectations of your surgical outcomes, and prepare for the possibility of the urethral diverticulum recurring.

    You should consider speaking to your family and loved ones about any anxiety or fears you may have about the surgery. You could also consider seeing a counselor/therapist for a more professional approach—we find that some hospitals provide pre-surgery counseling sessions.

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