Presentation of Female Urethral Diverticulum Is Usually Not Typical

Abstract

Introduction: Symptoms or signs of female urethral diverticulum are usually not typical, thereby resulting in delayed or wrong diagnosis. This paper relates to our experience on the diversity of presenting symptoms and signs of female urethral diverticula. Materials and Methods: We reviewed the medical records and conducted telephone interviews of 14 patients with the diagnosis of female urethral diverticulum in our institution. Results: The mean patient age at diagnosis was 47.5 years (range 22–65 years) and the mean duration between symptom presentation and diagnosis was 6.46 years (range 1 month to 30 years). Their presenting symptoms were so diverse that many were initially treated under the diagnosis other than urethral diverticulum. Most patients were treated as uncomplicated urinary tract infection for a long time. Stress urinary incontinence (SUI) was so dominant in 2 patients with big diverticula that they were falsely treated with anti-incontinence surgery. Total incontinence happened in 1 patient with genuine SUI and a big urethral diverticulum. One patient with a huge diverticulum, which had a fistula opening into the vagina, presented with day- and night-time incontinence. Some patients even did not have incontinence, but only had dysuria or a painful anterior vaginal wall nodule. Nevertheless, detailed analysis on symptoms and signs usually may suggest urethral diverticulum. We found that recurrent urinary tract infection, urinary incontinence, palpable suburethral mass, vaginal tenderness, and dysuria are the five major presenting symptoms and signs. The diagnostic rate of voiding cystourethrography during video-urodynamics, double-balloon urethrography and MRI were 10/10 (100%), 6/6 (100%) and 10/11 (90.9%) respectively. Conclusions: The presenting symptoms and signs of female urethral diverticula are often diverse and easily overlooked. High suspicion of this disorder, detailed history-taking and physical examination are essential for detecting urethral diverticulum in females.

Simultaneous Treatment of Female Urethral Diverticulum and Stress Urinary Incontinence with Urethral Diverticulectomy and Suburethral Synthetic Mesh Sling

“…Suprapubic cystostomy was removed 2 weeks later after confirming no urinary leakage over urethral wound by voiding cystourethrogram (VCUG). As shown in our previous study, 11 VCUG during VUDS detected 100% of UD, which was similar as using MRI. And since all our patients' UD were demonstrated by VCUG before surgery, therefore we continued to use VUDS to follow the postoperative conditions of these patients.…”

The Association Between Post-Void Leakage and Coital Incontinence and Intrinsic Sphincter Deficiency Among Women With Urinary Incontinence

“…25 The most frequent presenting signs and symptoms have been reported to be recurrent urinary tract infection, urinary incontinence, a palpable suburethral mass, vaginal tenderness and dysuria. 26 We believe that a high index of suspicion is necessary when evaluating women for urethral diverticula. However, in the absence of other urethral diverticula characteristics, physicians should feel comfortable to work-up their patients with post-void dribbling and coital incontinence with ISD first on their differential diagnosis.…”

Magnetic Resonance Imaging of Female Prostate Pathology

“…MRI has evolved as a perfect technique to study female pelvic anatomy [38][39][40][41]. Altogether, only a small number of studies on MRI of the paraurethral region have been conducted previously [31,38,42,43]. These studies focused on either erectile tissue or urethral diverticula.…”