DIVERTICULA OF THE FEMALE URETHRA

Objective To determine the optimum procedure for the diagnosis and the rapy of diverticula of the female urethra. Patients and methods The st udy included 18 patients with urethral diverticula treated at the Cris to Re Hospital in Rome between 1987 and 1995. Most of the patients wer e suffering from cystitis (eight), dysuria (seven) and recurring urina ry infections (II). Less frequently, more specific symptoms were prese nt such as post-voiding dribbling (two) and anterior vaginal mass (thr ee). The pre-operative evaluation included a history, physical examina tion, voiding and positive pressure voiding cysto-urethrography (VCUG) and urodynamic tests. A 'typical' surgical excision of the diverticul a was carried out in all cases. Surgical excision was combined with cy stopexis (Rat operation) in four patients with urinary stress incontin ence and three with detrusor instability were treated post-operatively with anticholinergics for 3 months. The outcome was evaluated by a ph ysical examination and urodynamic tests at 3, 6 and 12 months post-ope ratively; the mean (range) follow-up was 34 (2-80) months, Results All the urethral diverticula were in the distal two-thirds of the urethra , along the posterolateral wall. The VCUG was sufficient for diagnosis in eight patients while the other 10 required a positive-pressure VCU G. Fifteen patients were evaluated; complications included a urinary t ract infection for 2 months in four patients and stress incontinence f or 2 months in two. There were no recurrences or urethrovaginal fistul ae. Conclusions Diverticula in the female urethra are difficult to dia gnose because the symptoms can be misleading; the positive-pressure VC UG is useful in doubtful cases. However, a detailed history and physic al examination are mandatory.