A urethral diverticulum is a pocket that forms along the urethra that often causes pain, repeated urinary tract infections, and blood in the urine. The diverticulum can be excised completely through the vagina once imaging confirms the diagnosis.

What is Diverticulum?

A urethral diverticulum is a pouch or sac of inflamed tissue that protrudes from the urethra into the adjacent urethrovaginal tissue. It is often seen or felt as a mass or lump on the anterior vaginal wall under the urethra. It is postulated that the diverticulum may originate from a dilated periurethral duct or gland. The gland can become infected and obstructed and later rupture back into the urethra through a different tract. Most diverticula form in the distal 1/3 of the urethra, closest to the opening. Contributing factors to development of a urethral diverticulum may include a history of recurrent urinary tract infections, urethral trauma, and rarely after urethral sling if the urethral lining becomes compromised.

Symptoms of Urethral Diverticulum

The classic triad of symptoms found in patients with urethral diverticulum include:

• Painful urination (dysuria)

• Dribbling of urine after voiding

• Pain with intercourse (dyspareunia)

However, only about one third of patients report all of these during initial presentation, and therefore, other symptoms should be considered as well.

Recurrent urinary tract infections, discharge or drainage from the urethra, and urinary urgency and frequency may also be indicative of a urethral diverticulum.

Evaluation and Treatment of Urethral Diverticulum

Because the symptoms of a urethral diverticulum can be non-specific, a physical examination by a physician trained to recognize diverticula is key when the diagnosis is uncertain. Imaging studies may be used for confirmation if the exam is inconclusive. In our practice, we most often diagnose urethral diverticula based upon the patient’s history and physical exam and rarely are imaging studies required.

The excision of a urethral diverticulum is performed vaginally. It is key to excise the entire sac to prevent reformation, and this does require fine dissection and a keen knowledge of vaginal and urethral anatomy to avoid urethral injury.