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Diverticula of the Female Urethra: Diagnosis and Treatment

Definition of Female Urethral Diverticula

Urethral diverticula of the female urethra originate most commonly from periurethral glands of the distal or mid urethra and lead to a cavity within the endopelvic and periurethral fascia (Aspera et al., 2002) (Rufford and Cardozo, 2004).

Etiology of Female Urethral Diverticula

Acquired Diverticula of the Female Urethra

Most commonly, diverticula of the female urethra arise from infected periurethral glands. Like the duct of periurethral glands, the ostium of the diverticula is located posterolaterally in the mid or distal urethral. Recurrent infections and closures of the ostium lead to an enlargement of the diverticula within the endopelvic and periurethral fascia. The size of the diverticulum may vary between a few millimeters to several centimeters. Since the endopelvic and periurethral fascia confines the diverticulum, it may extend circumferentially around the female urethra.

Congenital Diverticula of the Female Urethra

There are only a few case reports about congenital diverticula in young girls; some showed spontaneous regression.

Signs and Symptoms of Urethral Diverticula

• Urinary frequency, dysuria
• Obstructive symptoms: weak urinary stream
• Recurrent urinary tract infection
• Dribbling
• Palpable vaginal mass
• Complications: abscess, stone formation, carcinoma of the diverticulum (rare)

Diagnostic Workup

• Cystoscopy and pelvic examination: basic examination for differential diagnosis, the ostium of the diverticulum can often be visualized.
• MRI: precise imaging for diagnosis and detailed anatomy of the diverticulum.
• Double-balloon positive-pressure urethrography or VCUG: facultative imaging with lateral or oblique images, a special catheter seals the urethra with a double-balloon and contrast media can be injected via a separate channel to fill the diverticulum.

Treatment of Female Urethral Diverticula

Transvaginal Excision

Transvaginal excision is the gold standard for surgical treatment of urethral diverticula.

• Incision and reflection of the anterior vaginal wall (inverted U incision)
• Opening of the periurethral fascia, dissection of the urethral diverticula
• Complete excision of the diverticula sac
• Closure of the urethra
• Closure of the periurethral fascia
• Closure of the vaginal wall

References

Aspera u.a. 2002 ASPERA, A. M. ; RACKLEY, R. R. ; VASAVADA, S. P.: Contemporary evaluation and management of the female urethral diverticulum.
In: Urol Clin North Am
29 (2002), Nr. 3, S. 617–24

Rufford und Cardozo 2004 RUFFORD, J. ; CARDOZO, L.: Urethral diverticula: a diagnostic dilemma.
In: BJU Int
94 (2004), Nr. 7, S. 1044–7

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