Urethral diverticulum Flashcards
What is a urethral diverticulum?
A urethral diverticulum is a herniation of the urethral mucosa through the muscle wall into surrounding tissue, forming a pocket-like outpouching that may collect urine or become infected.
What is the primary mechanism of urethral diverticulum formation?
Chronic infection, inflammation, or trauma to the urethra leads to weakening of the urethral wall, allowing the mucosa to herniate outward.
What are the major risk factors for developing urethral diverticulum?
- Repeated urinary tract infections
- Chronic urethral inflammation
- Vaginal delivery
- Prior pelvic surgery
- Pelvic trauma
What are the hallmark symptoms of urethral diverticulum?
- Hematuria
- Recurrent urinary tract infections
- Symptoms typically develop due to infection and distension of the diverticulum with purulent fluid.
- Dysuria
- Stress urinary incontinence
- Post-void dribbling
- Dyspareunia (painful intercourse)
- An anterior vaginal wall mass that may be tender
What classic case presentation should raise suspicion for urethral diverticulum?
A woman with a history of multiple vaginal deliveries presenting with dysuria, post-void dribbling, dyspareunia, and a tender anterior vaginal wall mass that expresses purulent or bloody fluid.
How does the history of multiple vaginal deliveries contribute to urethral diverticulum formation?
Vaginal deliveries can cause urethral trauma and chronic inflammation, weakening the urethral wall and predisposing it to diverticulum formation.
What urinary symptoms are associated with urethral diverticulum?
Hematuria, recurrent UTIs, stress urinary incontinence, and post-void dribbling.
What is the key finding on pelvic examination in urethral diverticulum?
A tender anterior vaginal wall mass that expresses purulent or bloody fluid on manipulation.
What is the initial step in evaluating a suspected urethral diverticulum?
Urinalysis and urine culture to assess for infection or hematuria.
What imaging studies are used to confirm urethral diverticulum?
MRI of the pelvis is the gold standard; transvaginal ultrasound is an alternative.
Why is a bladder or renal ultrasound not useful in diagnosing urethral diverticulum?
Because urethral diverticulum is a localized defect in the anterior vaginal wall, requiring high-resolution imaging like MRI or transvaginal ultrasound for proper visualization.
What conditions should be considered in the differential diagnosis of urethral diverticulum?
- Endometriosis
- Pelvic inflammatory disease (PID)
- Stress incontinence
- Skene’s gland abscess
- Gartner’s duct cyst
How does endometriosis differ from urethral diverticulum?
Endometriosis can present with dyspareunia but is not associated with UTIs or post-void dribbling. It also includes symptoms like dysmenorrhea (painful menstruation) and dyschezia (painful defecation), with physical findings of an immobile uterus, adnexal masses, and nodularity along the posterior cul-de-sac. A diagnostic laparoscopy can be performed to help diagnose endometriosis by visualizing and biopsying endometrial glands outside the uterus (eg, powder-burn lesions, endometrioma).
How does pelvic inflammatory disease (PID) differ from urethral diverticulum?
PID presents with fever, pelvic pain, dyspareunia, and mucopurulent cervical discharge. Cervical motion tenderness (chandelier sign) is a key finding, whereas urethral diverticulum presents with an anterior vaginal wall mass and post-void dribbling.
How is stress urinary incontinence differentiated from urethral diverticulum?
Stress incontinence causes urine leakage with increased abdominal pressure (e.g., Valsalva), but it does not present with dysuria, dyspareunia, or an anterior vaginal wall mass.
What are additional conditions that can mimic urethral diverticulum?
Skene’s gland abscess (painful mass near urethra with purulent discharge) and Gartner’s duct cyst (non-tender, asymptomatic anterior vaginal wall mass).
What are the treatment options for urethral diverticulum?
- Manual decompression or needle aspiration for small, uncomplicated cases.
- Surgical excision for larger or symptomatic diverticula.
- Antibiotics if secondary infection is present.
When is surgical repair indicated for urethral diverticulum?
Surgical repair is preferred for persistent symptoms, recurrent infections, or large diverticula that do not respond to conservative measures.
What is the most common complication of untreated urethral diverticulum?
Recurrent infections and abscess formation, which can lead to worsening urinary symptoms and chronic discomfort.
