A urethral diverticulum is an abnormal outpouching of the urethra. This outpouching or diverticulum can retain urine and infectious material.
The classic triad of symptoms include dribbling after urination, recurrent urinary infections, and dyspareunia which is pain with sexual intercourse. Patients may not have all of these symptoms and some patients may not have any of these symptoms of the diverticulum.
Sometime we don’t know but often the diverticulum is caused by an infected urethral gland that gets larger over time. Sometimes prior surgeries on the urethra can also cause a diverticulum.
Urethral diverticulum can be a difficult condition to diagnose and having suspicion for it and looking for the diverticulum is important. Not uncommonly I will see patients who have been treated with multiple rounds of antibiotics and never had been considered to have a diverticulum. Classically, especially when symptomatic, patients will be found to have tenderness on the urethra and a balloon like mass in the urethra during a vaginal exam. Unfortunately, many patients do not have these findings on exam which makes diagnosis difficult. Other ways to diagnose a diverticulum include a MRI or an x-ray study called a voiding cystourethrogram. On the X-ray study the diverticulum could be seen when contrast is retained in the urethral diverticulum after the patient urinates.
The best treatment ultimately is surgical. With this surgery the diverticulum is cut out and the urethra is closed back together. Sometimes if the diverticulum is very extensive a more extensive urethroplasty has to be performed to reconstruct the urethra.
Usually patients can go home the same day after surgery. The catheter will often be left in 41 to 2 weeks while the tissue heels. After this patience recovered fairly quickly and can resume most activities within six weeks after surgery.