Pathology
Histopathologically, several characteristics are frequently visible in urethral diverticula. These include nephrogenic adenoma, chronic inflammation associated with fibrosis around the glands, small or absent epithelium, chronic cystitis, cystitis cystica, cystitis glandularis, squamous metaplasia, and adenomatous metaplasia.Approximately 1/3 of diverticula are compound or multiple, and some can extend to surround the urethra. Diagnosis
Urethral diverticulum is often an incidental finding. It can be diagnosed using magnetic resonance imaging and/or micturating cystourethrography. Other studies that can be used to diagnose urethral diverticulum include intravenous urography, urethroscopy, and/or ultrasound. Conditions that should be distinguished from urethral diverticulum in a differential diagnosis include overactive bladder, Gartners duct cyst, Gartners duct abscess, ectopic caeco-ureterocele, interstitial cystitis, pelvic inflammatory disease, endometriosis, and cancer. Treatment
The primary treatment for urethral diverticulum is surgical. In women the surgery is conducted transvaginally, usually when there is no acute inflammation to better aid dissection of the delicate tissues. Prognosis
Left untreated, urethral diverticulum can cause significant morbidity (sickness).During surgery, there is a risk for complications due to the highly vascular nature of the tissue. The urethral sphincters and its smooth muscle, as well as the neck of the bladder, can be injured regardless of the surgical approach. Other complications from surgery can include urinary incontinence, stress incontinence, a urethrovaginal fistula, or recurrent diverticula. Horseshoe-shaped diverticula and diverticula that completely surround the urethra are both associated with worse outcomes, as are those located close to the bladder, and large (over 3–4 cm) diverticula.
Epidemiology
The incidence of urethral diverticulum has been increasing in the 2000s, likely due to increasing diagnosis and detection of the condition. It is estimated to be present in as low as 0.02% of all women and as high as 6% of all women, and 40% of women with lower urinary tract symptoms. Most symptomatic urethral diverticula are present in women from 30 to 60 years old.84% of periurethral masses are due to urethral diverticula. In men
Urethral diverticulum can occur in men, and can cause complications including kidney stones and urinary tract infections. == References ==