The urethra is the tube through which urine leaves the bladder and exits the body when a person urinates. The tube is only about 4 cm long in women. A condition known as urethral diverticulum (UD) occurs when an unwanted pocket or sac forms along the urethra. Because of its location, it can become filled with urine or even pus. This can lead to infections, pain, incontinence and other problems.
No, it’s relatively uncommon, although it’s diagnosed more often today. Now doctors have better imaging techniques available to explore the problem when patients report pain in this part of the body.
Still, it’s believed that some cases are not properly diagnosed because the condition is relatively rare, and the doctor doesn’t always think of it. UDs are seen most often in women between the ages of 30 and 60.
The cause isn’t always known. There seems to be a link between UDs and multiple bladder infections, which may weaken the urethra wall. A block in the glands near the urethra also may be to blame.
Many women with a UD feel discomfort in their pelvic area from the mass. They also may have:
Importantly, symptoms may come and go. About 20% of patients with a UD do not report having any symptoms at all.
Usually a urethral diverticulum is found during a routine pelvic exam or because a woman tells her doctor about symptoms she’s having. At that point, the doctor does a physical exam or orders tests to try to find the cause.
In a physical exam, a doctor will feel the vaginal wall to try to find any masses, as well as to identify the location of any soreness. If they feel a sac, they may give a gentle squeeze to see if any built-up urine or pus comes out. The doctor would typically also order a urine analysis for a patient at this point. If the exam leads the doctor to think there might be a problem, they can order imaging tests. These tests may include:
Magnetic resonance imaging: Magnetic resonance imaging (MRI) is a test that produces very clear pictures, or images, of the human body without the use of X-rays. MRI uses a large magnet, radio waves and a computer to produce these images. In people who might have a UD, the MRI will look all around the pelvis but particularly around the vagina to see if there are any masses present.
Ultrasound: This procedure transmits high-frequency sound waves, inaudible to the human ear, through body tissues. The echoes are recorded and transformed into video or photographic images of the internal structures of the body. This can show the doctor if there are problems with the structures of internal organs around the vagina and if there is any swelling or build-up of urine.
Cystoscopy: This test involves looking into the urethra or bladder to see if a diverticulum can be identified and see the location of its opening. This is often done in the office.
Surgery is often the best way to treat a UD, although it may not be the right choice for everyone. Some women prefer to wait and see if the UD gets bigger, or if their symptoms get worse, before deciding to have surgery. For those women, having regular follow-up visits to monitor their condition is very important.
A specialized urologist or urogyneologist most commonly performs this surgery because it’s a very sensitive area. It’s crucial that the urethra isn’t damaged in the procedure. Depending on many factors, such as the size and location of the UD sac, the doctor will most likely remove the sac. However, they can also choose to cut into the sac neck to drain the contents or to create an opening from the sac into the vagina that allows the contents to drain out that way. During the UD surgery, the doctor may also be able to fix certain urinary incontinence problems. Dr. Guerette has treated thousands of diverticulum and has developed a specialized technique to regain and protect continence using collagen grafts.
Most people will need to be on antibiotics for at least 24 hours after surgery and may have a catheter in their bladder to help them empty their bladder while they heal, usually two to three weeks. The surgeon may order a follow-up test a few weeks after surgery to see how the area is healing before removing the catheter.
"I think the thing that stood out most about the office is that I really felt like, Dr. Guerette understood what I was talking about when I started talking about some of the bladder issues I had. And number two,everybody just seemed really very caring. I really appreciated that."
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