TOG - Urethral diverticulum Flashcards
What is a urethral diverticulum?
A sac opening from the urethra, 3mm to 4cm
What is the prevalence of urethral diverticulum?
1-6%
Age at presentation 30-60yo
3 x higher in black > Caucasian
What is the aetiology of urethral diverticulum?
Congenital - ?remnants of Gartner’s duct or abnormal union of primordial folds
Most acquired - repeat infection and obstruction of the paraurethral glands
What is the ‘classic’ presentation of urethral diverticulum?
Dysuria
Post-void dribbling
Dysparunia
But may have variety of symptoms
What is the differential diagnosis of urethral diverticulum?
Interstitial cystitis Carcinoma in situ (esp if hard) Overactive bladder Vaginal wall cysts Urethral caruncle and mucosa prolapse Skene gland abnormality Vaginal leiomyoma Gartner’s duct cyst and abscess
Rarely: PID, endometriosis, ectopic caeco-ureterocele - check for duplex kidney
How many women will develop incontinence following urethral diverticulum excision?
17% - therefore need baseline urodynamics
What is the recommended imaging of urethral diverticulum?
MRI with T2 weighting
TVUS possible consideration if expertise not available
Voiding cystourethrogram
What are the complications of urethral diverticulum?
- Urinary tract infection (recurrent in 30-50%)
- Abscess
- Calculi
- Incontinence
- Neoplasm
How should urethral abscess be managed?
Not I&D as fistula may develop - aspiration and abx
Definitive surgery once resolved
How many patients with urethral diverticulum will have calculus?
1.5-10%
How frequent are urethral neoplasms and what are the predominant type?
6-9%
Adenocarcinomas in 40-60%
What are the 3 main surgical options for managing urethral diverticulum?
- Endoscopic re-roofing or transurethral incision
- widens neck of diverticulum. May get SUI - Marsupialisation of the urethral diverticulum sac
- may get splayed stream, high risk fistula. For
elderly/frail patients unable to have diverticulectomy - Diverticulectomy
- excision with vaginal graft flap - 70% cure rate
What are the complications of surgical treatment of diverticulae?
Recurrence 36%
SUI 17%
Fistula 6%
