A urethral diverticulum is a pouch in the floor of the urethra that may lead to infections, urinary incontinence or discomfort during intercourse.
In women, most are in the distal 2/3 of the urethra. About 10% of them may have a small stone in them, and rarely a cancer may develop within the diverticulum. Most cases in women are secondary to urethral infections or obstetric urethral injury.
This can be usually made by feeling and/or seeing a rounded cystic mass in the anterior vaginal wall which on compression may allow some discharge of urine and/or pus from the urethral opening. Cystoscopy, the post-void film on an IVP and/or a VCUG are likely to demonstrate the diverticulum. Sometimes, urethrography, which is performed by instilling x-ray dye down the urethra, can highlight a diverticulum.
Small, asymptomatic diverticula found on routine x-rays may not require surgical removal. Surgical correction is through a transvaginal flap technique for excision of the diverticulum, closing the urethral defect, and then closing the remainder of the defect with overlapping layers. A lightly packed vaginal tampon can be left for 24 hours. The Foley catheter can be left indwelling for 14 days or so prior to considering a voiding trial. Antibiotics and bladder antispasmodics are administered and intercourse discouraged for 6 weeks to allow healing.
Complications of urethral diverticulectomy may include stress urinary incontinence, urethrovaginal fistulae, recurrent diverticula or urinary tract infections.