The urinary tract is a complex system with several different parts. While many things can affect the kidneys, bladder, and urethra, infection and inflammation are most common. Still, other conditions do exist and can lead to discomfort and complications. One of these conditions is called urethral diverticulum (UD). Although it's not as common as urinary tract infections or urinary incontinence, it's still a urologic condition with frustrating symptoms that can range in severity. To help you better understand UD, we've put together a comprehensive guide that includes causes, symptoms, treatment options, and more.
What is Urethral Diverticulum?
Urethral diverticulum is a urologic condition in which a fluid-filled sac or "pocket" forms along the urethra, the tube that transports urine out of the body. Due to its location, the pocket often gets filled with urine during voiding, which causes the range of symptoms commonly associated with this condition.
Although the cause of UD is relatively unclear, some experts believe that the pocket forms after repeated infections that weaken the urethra lining. Others attribute the cause to blockages, excessive catheter use, and congenital defects.
Some doctors also believe that, due to the trauma that occurs during childbirth, UD can occur. The stress from childbirth can weaken muscles and glands near the urethra, which may result in the development of a urethral diverticulum.
How Common is Urethral Diverticulum?
Urethral diverticulum is considered a rare condition, but it still happens. With today's advancement in imaging technology, it's being diagnosed more often than before. However, some experts suggest that it's still being underdiagnosed or misdiagnosed due to previous misconceptions about its prevalence.
One of the most common conditions that gets mistaken for UD is interstitial cystitis (painful bladder syndrome). This chronic bladder condition is characterized by pelvic pain, urinary urgency, and frequency, often without bacterial infection. Other conditions that may be mistaken for UD in women include vulvodynia and endometriosis.
Due to anatomical differences, urethral diverticulum is more common in women, especially those between 30 and 70. However, it can still occur in men and individuals of any age, including children who have previously undergone urethral surgery.
Symptoms of Urethral Diverticulum
Some people who have urethral diverticulum may not experience any symptoms at all, while others face irritative problems such as urinary urgency, frequency, and dysuria. Unfortunately, many of the symptoms of UD are also common symptoms of other urologic conditions, which can result in a misdiagnosis when imaging techniques aren't used.
The most common symptoms or urinary system complications may include:
- Recurrent cystitis (UTIs)
- Multiple bladder infections
- Urinary incontinence
- Dribbling of urine
- Urinary retention
- Weak urine stream
- Hematuria
- Lower urinary tract symptoms
- Nocturia
- Pain during sex
- Pain during urination
- Urinary blockage
- Pelvic pain
- Vaginal discharge
- Tenderness in vagina
- Vaginal mass
- Abnormalities in penis or scrotum size
The size of the pocket next to the urethra doesn't seem to correlate with the severity of symptoms, meaning that small instances of UD can cause severe symptoms, and large UD can be largely asymptomatic. Additionally, UD symptoms may come and go, which can lead to fewer visits to the urologist and lack of a proper diagnosis. However, undiagnosed and untreated UD can also cause several complications and plenty of bothersome symptoms.
How is UD Diagnosed?
Diagnosing urethral diverticulum can be difficult since the symptoms are non-specific and quite common among several urologic conditions. Therefore, your urologist will likely use a range of tests to try and rule out other conditions and determine the underlying cause of your symptoms.
Physical Exam and Screening
Diagnostic screenings will begin with a general physical exam. Your urologist might ask you about your family medical history, an overview of current or previous symptoms, and any prior diagnosis regarding urologic conditions.
During a physical exam, your doctor may also try to express urine or pus from UD by applying slight pressure to the urethra. In women, UD may be found during a routine exam of the pelvis when feeling the vaginal wall.
Imaging Tests
Several imaging tests can be used to help diagnose UD, but each has unique advantages and disadvantages. Some of the most common urology tests include:
- Magnetic resonance imaging (MRI)—MRIs produce images of the affected area without using X-rays. Instead, they rely on magnetic radio waves to develop pictures of the pelvic region. MRIs are typically the most successful at identifying UDs and are often performed as follow-ups if irregularities are found in other imaging tests.
- Ultrasound — Using high-frequency sound waves, an ultrasound uses echoes to create images of the structures within the body.
- Cystoscopy — This involves inserting a camera into the urethra and bladder to check for any visible pockets or pouches.
- Voiding cystourethrogram — Using minimally invasive X-rays, this urodynamic study measures bladder function before and after voiding.
The type of imaging test that your doctor will order depends on the overall cost and availability of the test.
Treatment Options and Prognosis
After a complete evaluation and diagnosis of UD, your doctor can determine the appropriate treatment course. If your symptoms are mild and tend to go away on their own, your doctor may recommend active surveillance instead of surgery. Alternatively, patients may not want to undergo an operation or have the means to do so. Unfortunately, there's a lack of evidence regarding what happens when UD is left untreated.
Surgery
As of now, the only way to remove the sac is to undergo surgical removal of UD. However, this needs to be performed by an experienced surgeon who is well-versed in urologic care, as complications could damage the urethra. If damage occurs, reconstructive surgery may be needed, which is often more complicated than the initial incision. This is one reason that some individuals may choose to forego surgery and stick to active monitoring. The decision should be discussed in length with your urologist so you can clearly understand the risks involved.
Additional issues that you may experience after undergoing UD surgery include:
- Recurrent UD
- Urinary incontinence
- Urinary tract infections
- Urethrovaginal fistula
If the UD sac forms in the same area, it may be due to incomplete removal during the previous surgery. Unfortunately, repeated surgeries become more difficult and will require extremely high precision and skill to ensure the safety of a patient's urinary system.
Post-Treatment Care
After surgery, you'll need to be on antibiotics for at least 24 hours to reduce the risk of post-op infection. Your urologist will also insert an indwelling catheter, which will need to remain in place while your urinary system heals. You may experience mild bladder spasms following the surgery, which can be managed using prescription drugs.
About two to three weeks after surgery, you'll need to return for a follow-up appointment. At this time, your urologist may perform another voiding cystourethrogram to check the healing process. If there are no fluid leaks, your doctor will remove the catheter. If fluid is present, you'll need to schedule another follow-up appointment for the next week to repeat the test.
If you're experiencing any type of urologic symptoms, it's important that you schedule a visit with your urologist to obtain a proper diagnosis. The similarity of symptoms across different conditions can make undiagnosed, at-home care almost impossible, but there are ways to help you take back your life. For those with diagnosed urologic conditions, Byram Healthcare provides various urology resources and support as needed. We’re also proud to offer high-quality urologic supplies that can be discreetly delivered to your home at any time of the day. Visit our educational support page to learn more.
