An Overview of Urethral Diverticulum

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.

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

Symptoms of urethral diverticulum vary, 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 conditions are:

• Pain while urinating (dysuria)
• Blood in urine (hematuria)
• Leaking or dribbling after urinating
• Recurrent cystitis
• Frequent unitary tract infections (UTIs)
• Painful sexual intercourse
• Tender area or mass on the vaginal wall
• Bladder infections
• Pelvic pain

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.

Causes

You may be born with a urethral diverticulum 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 diverticulum 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 healthcare provider are:

• Physical examination: In women, the walls of the vagina can be examined and felt for tender masses or areas. Also, your healthcare provider 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 and surrounding structures.
• Cystoscopy: A cystoscopy is an in-office procedure in which the healthcare provider places a camera connected to a long tube into your urethra and bladde. This procedure can help in the diagnosis of a urethral diverticulum.
• Magnetic resonance imaging (MRI): MRI uses a large magnet and radio waves and a magnetic field to produce clear images of the body. In this case, it will be used to get detailed images of your pelvic area and vagina to detect any abnormalities. 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.

Treatment

Surgical excision is the main way to treat symptomatic urethral diverticulum.

The surgical options you have include:

• A complete removal or the pocket/sac. This is the most likely route your healthcare provider 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 healthcare provider. During your surgery, your surgeon 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 healthcare provider 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 healthcare provider 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).

A Word From Verywell

If you've been diagnosed with urethral diverticulum, it is important that you discuss your options extensively with your healthcare provider. You do not have to go through with having surgery if you don’t want to and your practitioner 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 medical professional 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.