Diverticula of the Female Urethra
Review literature: (Aspera et al, 2002) (Rufford and Cardozo, 2004).
Definition of Female Urethral Diverticula
Urethral diverticula of the female urethra originate most commonly from periurethral glands of the distal or mid urethral and lead to a cavity within the endopelvic and periurethral fascia.
Epidemiology
Women, 30–70 years old.
Etiology of Female Urethral Diverticula
Aquired 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 diverticula ostium leads to an enlargement of the diverticula within the endopelvic and periurethral fascia. The size of the diverticulum may vary between few millimeters to several centimeters. Since the diverticulum is confined by the endopelvic and periurethral fascia, it may extend circumferentially around the female urethra.
Congenital Diverticula of the Female Urethra
There are only 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)
 |
Vaginal mass due to a diverticula of the female urethra. By courtesy, Prof. Dr. R. Harzmann, Augsburg. |
Diagnostic Work-Up
- Urethro-cystoscopy
- Voiding cysturethrography
- Double-balloon positive-pressure urethrography: a special catheter seals the urethra with a double balloon, contrast media can be injected via a separate channel to fill the diverticula.
- Magnet resonance imaging (MRI)
Treatment of Female Urethral Diverticula
Transvaginal Excision
- Incision and reflection of the anterior vaginal wall (inverted U incision)
- Opening of the periurethral fascia, disection of the urethral diverticula
- Complete excision of the diverticula sac
- Closure of the urethra
- Closure of the periurethral fascia
- Closure of the vaginal wall
Marsupialization of Distal Female Urethral Diverticula:
The incision of the diverticula (at 6 o'clock) and the adaption of vaginal mucosa with the diverticula mucosa is the historic technique, which leads to a hypospadia of the female urethra. Due to better results of the transvaginal excision, marsupialization is only seldom used.
| Urethral caruncle | Index | Meatal stenosis |
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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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