Congenital anterior urethral diverticulum in children

Congenital anterior urethral diverticulum (CAUD) is an uncommon condition i n children usually presenting as a fluctuant ventral penile swelling. Retro spective data of nine patients with CAUD were analyzed. Patients presented with penile swelling (n = 7), recurrent urinary tract infection (UTI) (n = 5), and poor urinary stream (n = 2). One patient who had gross pyuria was t reated with initial marsupialization of the diverticulum and later underwen t a definitive surgical procedure. One had deranged renal function, grade I V vesicourethral reflux (VUR), and UTI and was treated with initial urinary diversion followed later by excision of the diverticulum and urethral reco nstruction. Of the seven patients who underwent primary repair of the diver ticulum, all except one had a normal urethrogram on follow-up. One patient developed a stricture of the urethra that was treated with dilatations and is presently asymptomatic. In the two patients who had bilateral VUR, one g rade III and the other grade IV, preoperatively, the reflux subsided and di d not require antireflux surgery. Only one patient is on low-dose urinary a ntibiotic prophylaxis and presently has grade II reflux. Primary excision a nd repair is the preferred mode of treatment for CAUD. CAUD producing obstr uctive uropathy and VUR can be managed conservatively. In the presence of g ross pyuria, marsupialization of the diverticulum followed by definitive su rgery at a later date is safe and recommended.