Female Urethral Diverticulum: Current Diagnosis and Management

Abstract

While urethral diverticulum (UD) affects less than 20 per 1,000,000 women overall, it is thought to represent 1.4 % of women with incontinence presenting to urology practices. It is hypothesized to evolve from periurethral glands that become obstructed, infected, and dilated over time, and patients typically present with dyspareunia, bothersome lower urinary tract symptoms (LUTS), and/or recurrent UTIs. In many patients, a periurethral mass can be appreciated on exam. In recent years, magnetic resonance imaging (MRI) has become the imaging test of choice for diagnosis of UD, but ultrasound (US) is a readily available alternative and provides good specificity at a lower cost. Surgical excision of the diverticulum with tension-free, water-tight, three-layer closure continues to be the mainstay of treatment of UD with most studies reporting cure rates of >90 %. Concomitant treatment of preexisting stress incontinence with autologous fascial pubovaginal sling can be used at the time of diverticulectomy to avoid a secondary procedure. However, since secondary anti-incontinence procedures are needed in only a small number of patients, up-front stress incontinence treatment may result in significant overtreatment, and staged anti-incontinence procedures continue to be a reasonable option for patients with persistent bothersome stress urinary incontinence (SUI) after diverticulectomy.

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Iryna M. Crescenze declares no potential conflicts of interest.

Howard B Goldman is a section editor for Current Urology Reports.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Correspondence to Howard B. Goldman.

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This article is part of the Topical Collection on Lower Urinary Tract Symptoms & Voiding Dysfunction

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Crescenze, I.M., Goldman, H.B. Female Urethral Diverticulum: Current Diagnosis and Management. Curr Urol Rep 16, 71 (2015). https://doi.org/10.1007/s11934-015-0540-8

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Keywords

  • Female urethral diverticulum
  • Urethral imaging
  • Urethral reconstruction
  • Pubovaginal sling