Primary carcinoma of a urethral diverticulum is still rarer and clear cell adenocarcinoma of the urethra is particularly uncommon (Swartz et al., 2006). However, if a woman is symptomatic, surgical excision is the treatment of choice. It is not known if the pockets will become larger or if symptoms will get worse. This is an uncommon condition that is found mainly in adult women. Small asymptomatic diverticula can be noted in patients' charts and monitored. Radiographics. Hyams JA, Hyams MN. Treatment consists of surgically removing the bulge (urethral plication). Because it most often connects to the urethra, this outpouching repeatedly gets filled with urine during the act of urination thus causing symptoms. What are the symptoms of a urethral diverticulum? Diagnosis & Available Treatments. Primary urethral carcinoma is extremely rare and is marked by a variety of clinical symptoms. Leach GE, Schmidbauer CP, Hadley HR, Staskin DR, Zimmern P, Raz S. Introduction. 1999;83(4):522-3. Potential adverse effects after surgery are new-onset USUI, urethrovaginal fistula and urethral stricture. There are few complications after surgical treatment. Female Urethral Diverticulum: Diagnosis, Treatment and Outcome. Treatment of urethral diverticulum. Because it connects to the urethra, this outpuching repeatedly fills with urine when you empty your bladder and causes symptoms. A urethral diverticulum is an abnormal pouch in the floor of the urethra that may lead to infections, urinary incontinence or discomfort during intercourse. Treatment of urethral diverticulum is indicated if patients are symptomatic. Diverticulum of the female urethra: an improved technique of surgical excision. Hirschorn RC. Moore TD. Treatment is indicated if the diverticulum is thought to be the cause of symptoms or if complications ensue. Urethral Diverticulum. This procedure removes the diverticulum through a cut in your vagina. A urethral diverticulum is an unusual defect along the urethra, where a “pocket” or sac forms inside the urethra. Urinary incontinence is frequently associated with a urethral diverticulum in female patients. Urethral diverticula occur in 0.02–6.00% of women worldwide. Those who have symptoms, however, are most likely to notice problems with urination. CT voiding urethrography (virtual urethroscopy) consists of a CT during VCUG; reformatted images are viewed interactively on a workstation; the technique is however still experimental 1,3; MRI. The present case is of interest because, to our knowledge, chemotherapy for adenocarcinoma of the female urethral diverticulum has never been reported. Surgical treatment of female urethral diverticulum. Our patient exemplifies the unfortunate norm for this condition: patients often live with symptoms for years before receiving a diagnosis and undergoing treatment. Urethral diverticulum is a condition in which a variably sized “pocket” or outpouching forms next to the urethra. Urethral diverticulum is often an incidental finding. Semin Urol. A urethral diverticulum is a small pocket or outpouching off the urethra. An estimated one to six percent of women have this condition, and early diagnosis and treatment is important. The possibility of this diagnosis is often overlooked, even in women with presenting symptoms or findings (eg, urinary incontinence, dysuria, dyspareunia, vaginal mass). These may be congenital or result from blocked or infected glands in the urethra. Urethral diverticulum is also a rare entity with a prevalence of 1-6%. These are complex vaginal reconstructive surgeries that should be undertaken by an experienced surgeon. Author information: (1)Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California. Urethral diverticulum. Urethral Diverticulum Tom Walton January 2011 1 Urethral diverticulum Underdiagnosed Incidence estimated up to 5% female population Age 20-60 yrs Originally thought to be either congenital or acquired – now accepted to be acquired secondary to infection of periurethral glands located in periurethral fascia on vaginal aspect of distal two-thirds of urethra. 13. J Urol 1952;68:611–6. 11. Little is known about the natural history of an asymptomatic diverticulum and whether it will increase in size or become symptomatic in the future. A urethral diverticulum is a localized outpouching of the urethral mucosa into the surrounding non-urothelial tissues . Urethral anomalies, such as enlargements of Littre’s or Cowper’s ducts, diverticula and urethral polyps, are rare causes of hematuria, which are diagnosed by careful voiding cystourethrogram studies. Some patients may not want it, or be able to have surgery. Surgical treatment of concomitant urethral diverticulum and stress incontinence. Research suggests that somewhere between 40 and 100 percent of women … Tests such as an MRI scan of the bladder and urethra can also confirm the diagnosis. What is the treatment for a urethral diverticulum? Due to the close proximity to the urethra, this outpouching can get filled with urine and may cause urinary frequency, urgency, and pain. The diverticulum in the fossa navicularis was shown to be another cause, which may not be so rare and can be detected and corrected readily. A urethral diverticulum is mainly recognised based on the symptoms and through physical examination: sometimes a swelling is visible on the front wall of the vagina during urination. What are the alternatives? Urethral diverticulum treatment. Indications for future treatment could include the onset of symptoms, hematuria not attributable to another cause, and an increase in size. Once your urethral diverticulum is properly diagnosed and treated surgically by an experienced urologist, your outlook is excellent. Delayed or missed diagnosis of … 1986 Feb;4(1):33-42. BJU Int. Urethral diverticulum (UD) is a condition in which an outpouching or pocket forms from the urethra and into the anterior vaginal wall. It is very important that the whole lining of the urethral diverticulum is removed to prevent recurrence and to ensure that the neck of diverticulum is closed in such a way to prevent postoperative urethrovaginal fistula formation. It can be diagnosed using magnetic resonance imaging and/or micturating cystourethrography. A new surgical technique for urethral diverticula in women. South Med J 1938;31:1043–7. For help, contact us at (888) 268-1108. Often an asymptomatic diverticulum is discovered on a routine physical examination or an imaging study done for another reason. A giant urethral diverticulum presenting as a scrotal mass in an adult male. The preferred treatment for a urethral diverticulum is surgical excision. Bass JS(1), Leach GE. Asymptomatic women can be managed conservatively, whereas a standard therapy for symptomatic women is surgical excision, diverticulectomy, with cure rates ranging from 70–97% in the reported literature.3, 10, 21 The reoperation rate for primary urethral diverticulum repair in a contemporary series was approximately 9%. Common symptoms. Often the surgeon will order an MRI of the pelvis to identify the complete extent of the diverticulum and to ensure there are no solid components. Urol Cut Rev 1939;43:573. New operative procedures for treatment of diverticulum of female urethra. In cases of an asymptomatic urethral diverticulum, treatment is not mandated. Pelvic organ prolapse occurs in women when pelvic floor muscles don't support the uterus, bladder, ureter, vagina, cervix, small intestines and/or the rectum. 1-6 The treatment strategy has never been established due to the rarity of this entity. Not all urethral diverticula need to be treated. A cystoscope can also be used as a means of seeing into the urethra. It can also present itself as a pocket in the urethra herniating into the vaginal wall. 12. In some cases one may choose not to treat the diverticulum and elect observation. Not much is known about untreated urethral diverticulum. Removing the pouch through surgery is the primary treatment option, although there are other methods depending on the severity of the case. 1998;18:517-32. Cystography in patients with a possible urethral diverticulum; A complete urodynamic evaluation to evaluate bladder function. Guérin … Evaluation and Treatment of Urethral Diverticulum. 3 … Urine can collect in these and cause dribbling urine leakage after voiding, (post void dribble). Resident’s teaching files: MR imaging diagnosis of a urethral diverticulum. Cystourethroscopy in patients who are suspicious of interstitial cystitis; Bladder biopsy when patients are suspicious of bladder cancer or urethral cancer. Who usually gets urethral diverticulum? Still, not all cases call for surgery. Cause of symptoms. A urethral diverticulum is a “pocket” or outpouching that forms next to your urethra (waterpipe). Urethral diverticulum is a pouch or cyst next to the urethral wall. A combination of diagnostic tools can be used depending on each patient. Khati NJ et al. Common symptoms reported by people with urethral diverticulum. Alternative treatments for urethral diverticulum These are some of the other types of treatment methods used in treatment of urethral diverticulum: Endoscopic procedures – A knife electrode effectively helps to open the diverticula into the urethral lumen. Imaging studies may be used for confirmation if the exam is inconclusive. How bad it is. As we've already seen, it's possible to have a urethral diverticulum without also experiencing symptoms, or to have symptoms that are so vague that they won't alarm you enough to seek medical attention. Urethral Diverticulum Our urologists treat urethral diverticulum, a condition in which a pouch develops by the urethra that holds urine, often leading to infections. Urethral diverticula are a relatively common finding among women with chronic genitourinary conditions, such as recurrent infections, post void dribbling, and dyspareunia (difficulty or painful intercourse). 1 As a result, the index of suspicion must be high. In order for urethral diverticulum to be properly diagnosed so that treatment can begin, you’ll likely need an MRI scan, which should help to identify the placement and size of the sac. 6,7 For every 1 million women undergoing pelvic surgery <0.01% are reported to have a urethral diverticulum… Urethral Diverticulum: Symptoms. Adenocarcinoma of the female urethral diverticulum is an uncommon lesion. 1. To date, 73 cases of this entity have been reported. Because the symptoms of a urethral diverticulum can be non-specific, a physical examination by a physician trained to recognize diverticula is key when the diagnosis is uncertain. Pre-existing urodynamically proven stress urinary incontinence (USUI) resolves in 50% of patients after excision of the diverticulum with Martius labial fat pad interposition without the need for further treatment. Quoraishi SH et al. Rarely, you may have a recurrence of your UD if it wasn’t completely removed during surgery. Surgery is the treatment of choice for symptomatic urethral diverticula and includes complete or partial excision or marsupialization, depending mainly on the location of the diverticulum along the urethra [1, 6].If the diverticulum opens into the middle or proximal third of the urethra, the treatment of choice is urethral diverticulectomy, which is usually performed transvaginally. Urology Specialties, Conditions, Treatments & Technology. Surgery is the main way to treat urethral diverticulum. Treatment options. Treatment of female urethral diverticulum. A urethral diverticulum may be visualized at CT as a cystic mass with wall thickening and enhancement at the level of the pubic symphysis 3.
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