Fact-sheet: Urethral diverticulum
Updated on 06/23/2020 at 8:57 AM
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Definition
Urethral diverticulum, or subUrethral pouch, is defined as a herniation of the urethral mucosa through the smooth muscle fibers that make up the urethral wall. It forms a blind pouch often communicating with the urethral lumen via a neck and protrudes into the vaginal wall
Clinical features
- Adult form: between the 3rd and 5th decade of life
- Congenital form: rare cases reported in newborns or young girls
- recurrent Cystitis
- irritative symptoms: urinary frequency, urgency
- dyspareunia
- sometimes asymptomatic
- On palpation, there is an anterior vaginal mass. Compression of this pouch results in expression of pus/blood/urine from the urethral meatus
Radiography
Retrograde and voiding urethrocystography during the voiding phase: identifies the neck and demonstrates a small diverticulum (subUrethral pouch) located in the middle or distal third of the urethra
Ultrasound
Suprapubic and endovaginal approach:
SubUrethral fluid collection that may contain a calculus, with walls of variable thickness depending on the degree of local inflammation or infection
May be bilobed, horseshoe-shaped
MRI
- T1: variable signal depending on its content (iso-, hypo-, or hyperintense)
- T2: hyperintense signal ringed by a peripheral hypointense rim (urethral muscle fibers)
Evaluation:
Anterior, lateral, and bladder neck peri-urethral extension
The ostium (to guide the surgeon)
Intradiverticular septa, intradiverticular calculus, tumor, or granuloma
Management
Surgical management consisting of transvaginal diverticulectomy
Differential diagnosis
- Abscess of Skene's periurethral glands
- Bartholin gland cyst
- Gartner duct cyst
- Prolapse of a Ureterocele
- Periurethral or vaginal fibromyoma
- Hemangioma
- Urethral varices
- Urethral endometriosis
- Vaginal metastasis