Urethral diverticula: a diagnostic dilemma

OBJECTIVE: To review the urethral diverticula encountered in a tertiary-referral urogynaecology unit. PATIENTS AND METHODS: The case-notes of all women who had a diverticulectomy between March 1996 and May 2001 were reviewed. Demographic details, symptoms at presentation, duration of symptoms before diagnosis, investigations, operative details, postoperative complications and symptoms at follow-up were considered. RESULTS: In all, 18 women had had a urethral diverticulectomy. The median (range) time from presentation to diagnosis was 9.5 (2-96) months. The symptoms before surgery were variable; after surgery there were significant improvements in the symptoms of frequency, terminal dribbling and recurrent urinary tract infections (P < 0.05). There was no improvement in urgency, urge incontinence, nocturia and stress incontinence. Eleven of the 18 diverticula were palpable on vaginal examination. Video cysto-urethrography was used in 15 women and the diverticulum was seen in 14. In addition, seven women had additional lower urinary tract pathology. CONCLUSIONS: Urethral diverticula have no classical presentation; they often present with many symptoms and it is important that the diagnosis is not overlooked. Video cysto-urethrography is a good diagnostic test and allows the simultaneous evaluation of function of the whole of the lower urinary tract.