Urethral Diverticulum Treatment and Management
Medically reviewed by Jamin Brahmbhatt, MD
Your urethra is a tube through which urine from your bladder flows through to leave the body when you urinate. A urethral diverticulum (UD) is a pocket or pouch that forms along the length of your urethra. This pocket, because of where it's positioned, gets continuously filled with urine when you urinate, and this sometimes leads to pain, problems urinating, frequent infections, and urinary incontinence.
Although rare, a urethral diverticulum can also lead to the formation of urethral calculus, a hard stone formed in the urethra as a result of the build-up of stagnant urine and salt deposits in the diverticulum.
Urethral diverticulum is generally not a common condition, though it happens more frequently in women than in men.
This article looks at the symptoms and causes of urethral diverticulum. It also explains how the condition is diagnosed and what can be done to fix it.
Symptoms of a Urethral Diverticulum
Symptoms of a urethral diverticulum can vary, and their presence and severity are usually unrelated to the size of the pouch/sac. Indeed, you may have a urethral diverticulum and not experience any symptoms.
Some of the common symptoms of this condition include:
Leaking or dribbling after urinating
Recurrent cystitis
Frequent unitary tract infections (UTIs)
Tender area or mass on the vaginal wall
Pelvic pain
Is urethral diverticulum serious?
While there may be no symptoms at first, urethral diverticulum can become potentially serious when an infection develops.
You may only experience some but not all of these symptoms. In addition, they may not be constant—they may disappear for long periods only to return later on.
Related: How a Urinary Tract Infection Is Treated
What Causes Urethral Diverticulum?
You may be born with a urethral diverticulum or you may acquire one. Congenital urethral diverticulum (present from birth) usually stems from Gartner duct cysts and Müllerian duct cysts.
The cause of acquired urethral diverticulum isn't always known but it has been linked to obstruction of the urethral glands and multiple bladder infections that are thought to weaken the walls of the urethra. Trauma during a vaginal birth has also been identified as a contributor to the formation of urethral diverticulum.
Diagnosing a Urethral Diverticulum
The symptoms of urethral diverticulum are not specific—it shares the symptoms of many other bladder or urethra-related conditions. Some people are misdiagnosed and treated for other conditions like cystitis and vulvodynia for many years.
It’s also sometimes diagnosed completely by accident, like when imaging tests for entirely different reasons are carried out. The most reliable ways urethral diverticulum can be diagnosed by your healthcare provider include:
Physical examination: In women, the walls of the vagina can be examined and felt for tender masses or areas. Also, your healthcare provider may try to express pus or urine from the urethral diverticulum space.
Ultrasonography: This method will involve using ultra (high frequency) sound waves to obtain pictures of your urethra and surrounding structures.
Cystoscopy: A cystoscopy is an in-office procedure in which the healthcare provider places a camera connected to a long tube into your urethra and bladder. This procedure can help in the diagnosis of a urethral diverticulum.
Magnetic resonance imaging (MRI): MRI uses a large magnet, radio waves, and a magnetic field to produce clear images of the body. In this case, it will be used to get detailed images of your pelvic area and vagina to detect any abnormalities. Currently, this is accepted as the best test to diagnose urethral diverticulum.
Voiding cystourethrogram (VCUG): This involves an X-ray of your bladder and urinary tract taken while you are urinating.
Treatment Options for Urethral Diverticulum
Surgical excision is the main way to treat symptomatic urethral diverticulum.
Takeaway
Because of its highly technical nature, if you choose to have surgery, it will have to be performed by a specialist called a urogynecologist.
The surgical options you have include:
A complete removal of the pocket/sac. This is the most likely route your healthcare provider will recommend.
Cutting into the neck of the pocket/sac and draining its contents completely.
Spence procedure, which involves making an opening of the urethral diverticulum into the vagina. That is, an opening will be made for the contents of the sac/pocket to be able to flow out through the vagina.
The surgical option chosen depends on the size and location of the urethral diverticulum, as well as other factors identified by your healthcare provider.
What to Expect Before, During, and After Surgery
Any infection you may have must first be resolved before surgery can be performed.
During your surgery, your surgeon may also be able to fix any incontinence issues you may have been experiencing. After surgery, you’ll likely be given some antibiotics for at least 24 hours to prevent infections. You may also be fitted with a catheter that’ll remain in place for some weeks for better healing. You’ll be instructed to show up for follow-up tests in subsequent weeks to check the success of the surgery, the status of your healing, and to remove the catheter.
What Are the Risks of Surgery?
As with any surgical procedure, there are risks associated with urethral diverticulum surgery, including:
Bleeding
Infection
Urethrovaginal fistula
Urethral scarring
Recurrence of the urethral diverticulum
You should discuss all of these with your healthcare provider before consenting to the surgery.
Watch-and-Wait Approach
Alternatively, you may want to wait to see if your symptoms get worse or the urethral diverticulum gets bigger before considering surgery. It is also possible that you don't want to undergo surgery at all. In that case, your healthcare provider will help devise a management plan. However, you should know that, as it stands, not much is known about leaving urethral diverticulum untreated—there’s no way to know if the pockets will get bigger or if your symptoms will worsen.
You should also know that, although it’s very rare, there have been cases of carcinoma (a type of cancer) developing in people with urethral diverticulum.
Summary
Urethral diverticulum refers to a pocket or pouch that forms along the length of your urethra. It can cause symptoms such as pain, urinary tract infections, and incontinence. If you've been diagnosed with urethral diverticulum, it is important that you discuss your options extensively with your healthcare provider; surgical treatment may be necessary.
Read Next: Tips for Keeping Your Urinary System Healthy
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