Lj. Romanzi et al., Urethral diverticulum in women: Diverse presentations resulting in diagnostic delay and mismanagement, J UROL, 164(2), 2000, pp. 428-433
Purpose: We describe various clinical presentations of urethral diverticulu
m, which may mimic other pelvic floor disorders and result in diagnostic de
lay. Management and outcome results are reported.
Materials and Methods: We reviewed retrospectively 46 consecutive cases of
urethral diverticulum. Patient characteristics, history, clinical evaluatio
n, management and long-term followup are reported.
Results: Mean patient age plus or minus standard deviation was 36.3 +/- 11.
7 years. Most (83%) cases were referred as diagnostic dilemmas with symptom
s present for 3 months to 27 years. Mean interval between onset of symptoms
to diagnosis was 5.2 years. The most common symptoms were pain (48% of cas
es), urinary incontinence (35%), dyspareunia (24%) and frequency/urgency (2
2%). The number of physicians previously consulted ranged from 3 to 20 and
prior therapies included oral and/or vaginal medications, anti-incontinence
surgery and psychotherapy. The diverticulum was palpable on examination in
24 patients (52%), in only 6 of whom was it possible to "milk" contents pe
r meatus. Of these 24 palpable diverticula 2 contained malignancy, and 2 ot
hers contained endometriosis and stones, respectively. Diagnosis was made b
y voiding cystourethrography in 30 cases (65%), double balloon urethrograph
y in 5 (11%) and transvaginal ultrasound or magnetic resonance imaging in 7
(15%). Diverticula were incidental findings during vaginal surgery in 4 ca
ses (9%). Treatment consisted of diverticulectomy and/or Martius flap, pubo
vaginal sling and urethral reconstructive procedures when indicated in 35 c
ases (76%), and 2 other patients underwent radical surgery for diverticular
malignancy. Subsequently all but 2 patients with pain were cured. In anoth
er patient de novo stress incontinence developed postoperatively. None of t
he patients who underwent concomitant pubovaginal sling had postoperative i
ncontinence.
Conclusions: The symptoms of urethral diverticulum may mimic other disorder
s. This condition should be considered in women with pelvic pain, urinary i
ncontinence and irritative voiding symptoms not responding to therapy. Surg
ical treatment is usually effective in alleviating associated symptoms.