Urethral Diverticulum

The urethral Diverticulum is a condition that occurs when an unwanted sac or pouch is formed along the urethra. This could lead to infections and other related problems, because of the location it may get filled with urine or pus. This is a rare condition, but more common in women aged between 40 to 70 years.

Usually, signs and symptoms are hard to pinpoint and are highly variable, making the urethral diverticulum especially hard to diagnose. Symptoms may not be apparent at all times and may disappear for some time and come back again. But most common are

• Recurrent UTIs,
• Pelvic pain
• Lower urinary tract symptoms
• Nocturia
• Pain during intercourse
• Dribbling of urine after they urinate
• Blood in urine
• Vaginal discharge
• Urinary blockage
• Incontinence
• Unable to empty the bladder

The exact cause of the urethral diverticulum is not known. It seems to have a link between the urethral diverticulum and multiple bladder infections, which may weaken the urethral wall.

There could be a block in the glands near the urethra that might cause it.

It is also linked to a birth defect or trauma during childbirth.

Usually, UD is found during a routine pelvic exam or when the patient tells the doctor about the symptoms she is having. The doctor then does a physical exam and conducts tests to diagnose the cause.

• Physical exam
• Previous health history
• Urine tests
• Endoscopic exam of bladder and urethra
• MRI scan
• Ultrasound scan

Surgery is the best way to treat the urethral diverticulum. But it may not be right for everyone. Some women may prefer to wait and see if UD is growing or if their symptoms get worse, before deciding on the surgery.

UD surgery is performed by an experienced and specialized urologist because it is a very sensitive area. The UD sac is almost attached to the urethral opening, therefore if the sac is not removed carefully, it can damage the urethra. This might lead to another major surgical repair.

Surgical options are:

• cutting into the sac neck,
• opening the sac permanently into the vagina,
• completely removing the sac called diverticulectomy.

Along with this surgery, additional procedures are done to prevent the UD from returning. They are -

• closing the diverticular neck,
• the lining of the diverticular sac should be removed completely to prevent UD from coming back.
• closing with many layers is required so that a new opening doesn’t form between the urethra and vagina,
• if you also have stress urinary incontinence, then a procedure to fix the leaking may be done at the same time during the UD surgery.

The recovery from UD surgery usually takes 2 to 3 weeks. You would be given antibiotics for up to a week after surgery. The doctor will place a catheter during the recovery process.

After 2 or 3 weeks of surgery, a voiding cystourethrogram (VCUG, an X-ray using dye) will be done.

• the catheter is removed, if there is no fluid leaking,
• if any fluid is noticed, a repeat VCUG will be done weakly until leaking ends.