Urethral diverticulum in women occurs when the urethra pushes or is pushed into the vaginal wall. The portion of the urethra usually responsible is in the middle or outer edge (exit point). Most often this is due to enlargement of the Skene’s glands (female prostate, periurethral glands).
Urethral diverticulum is being diagnosed more and more frequently as practitioner awareness increases. Urethral diverticulum sometimes comes with urethral cancer or calculi, however overall incidence appears pretty low, maybe due to misdiagnosis or the problem being asymptomatic and not well known. The most common age group is between 30 and 60 years, and children are rarely affected.
Why does urethral diverticula occur?
There are several theories as to why urethral diverticula develop. One is that it is congenital (we’re born with it). It could be a remnant of the Gartner duct, faulty skin connections, Mullerian cysts, or periurethral cysts (Skene’s, female prostate), however most physicians seem to agree that this condition is acquired. There seems to be a problem with the Skene’s glands becoming obstructed, causing diverticula of the urethra eventually.
Diverticula means a blind, tube-like sac or another type of area that branches off from a canal or cavity. A diversion, if you like.
The periurethral glands line the urethral wall and most of them drain into the urethra near the opening. An infection in these glands can cause an obstruction, with more infections leading to more obstruction.
This can cause enlargement of the glands, which can develop into a cyst or abscess cavity. If this cyst or abscess cavity ruptures, it causes a connection to be made between the urethral lining and the cyst, which results in urine pooling, causing the urethral diverticulum.
The diverticulum can adhere to neighbouring walls and result in fibrosis. If infection continues, the vagina can be eroded in some way.
The size and shape and position of diverticulum varies somewhat, as does the bacteria found inside them. It can be Escherichia coli, species of chlamydia and more rarely, gonorrhoea.
Symptoms of urethral diverticula
- Dribbling after urination (post-void dribbling)
- Frequency and urgency to urinate
- Pain or discomfort on urination
- Severe pain
- Painful sex (dyspareunia)
- There may be a mass inside the vagina
- Bloody urine
- Recurrent urinary tract infections
- May look like interstitial cystitis, overactive bladder, cancers, other types of cysts or ectopic ureterocele
- The mass may have stones, infection, obstruction of the bladder or malignancy within
- Infection can be chronic
Diagnosis of urethral diverticula
Diagnosis is made after pelvic examination is performed that likely finds the very tender mass. Cultures may need to be taken from urine and possibly fluid from the diverticulum itself. X-rays, MRI or other scans may be taken.
Treatment of urethral diverticula
Most often surgery is performed, with good success rates and low recurrence rates of the issues. No medicine is available to help with this very physical problem, though many women may benefit from oestrogen therapy.
The success rate is between 86 and 100 per cent, which is pretty good odds. Surgery doesn’t come without risks, but they can be managed by your surgeon and doctor.
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