Urethral diverticulum in women: diverse presentations resulting in diagnostic delay and mismanagement.
OBJECTIVE
We describe various clinical presentations of urethral diverticulum, which may mimic other pelvic floor disorders and result in diagnostic delay. Management and outcome results are reported.


METHODS
We reviewed retrospectively 46 consecutive cases of urethral diverticulum. Patient characteristics, history, clinical evaluation, 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 symptoms 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 cases), urinary incontinence (35%), dyspareunia (24%) and frequency/urgency (22%). 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 per meatus. Of these 24 palpable diverticula 2 contained malignancy, and 2 others contained endometriosis and stones, respectively. Diagnosis was made by voiding cystourethrography in 30 cases (65%), double balloon urethrography in 5 (11%) and transvaginal ultrasound or magnetic resonance imaging in 7 (15%). Diverticula were incidental findings during vaginal surgery in 4 cases (9%). Treatment consisted of diverticulectomy and/or Martius flap, pubovaginal sling and urethral reconstructive procedures when indicated in 35 cases (76%), and 2 other patients underwent radical surgery for diverticular malignancy. Subsequently all but 2 patients with pain were cured. In another patient de novo stress incontinence developed postoperatively. None of the patients who underwent concomitant pubovaginal sling had postoperative incontinence.


CONCLUSIONS
The symptoms of urethral diverticulum may mimic other disorders. This condition should be considered in women with pelvic pain, urinary incontinence and irritative voiding symptoms not responding to therapy. Surgical treatment is usually effective in alleviating associated symptoms.
Romanzi
L J
LJ
Departments of Obstetrics and Gynecology, and Urology, Weill Medical College, Cornell University, New York, New York.
Groutz
A
A
Blaivas
J G
JG
D000293:Adolescent; D000328:Adult; D000368:Aged; D003937:Diagnosis, Differential; D004240:Diverticulum / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D004414:Dyspareunia / Q000209:etiology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D011183:Postoperative Complications; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome; D014521:Urethra / Q000000981:diagnostic imaging; D014522:Urethral Diseases / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014545:Urinary Calculi / Q000150:complications; D014549:Urinary Incontinence / Q000209:etiology; D014550:Urinary Incontinence, Stress / Q000209:etiology; D014555:Urination Disorders / Q000209:etiology