Urethral diverticulum (UD) is a rare condition in which a pocket, sac, or pouch forms in the urethra. The urethra is a small tube through which urine passes to exit your body. Because this sac is in the urethra, it can fill with urine and sometimes pus. The urine or pus that is trapped in the UD can become infected and cause issues or symptoms.
UD occurs almost always in women, but can more rarely occur in men. While UD can occur at any age, it’s more common between the ages of 30 to 60.
The symptoms of UD can vary from person to person. You also may not show any notable signs or symptoms if you have the condition. However, the most common symptoms of UD may include:
- frequent urinary tract or bladder infections
- bloody urine
- painful sex
- pain in the pelvic area
- overactive bladder
- urinary incontinence, or leaking urine when you laugh, sneeze, or cough
- leaking urine after you empty your bladder
- pain when you urinate
- vaginal discharge
- urinate multiple times at night
- blockage in the urinary tract
- difficulty emptying your bladder
- tenderness in the vaginal wall
- mass in the front of the vaginal wall that you can feel
These symptoms may also be signs of other conditions, which makes early and proper diagnosis important if you have any of these symptoms.
The exact cause of a UD is unknown. However, several conditions may be linked to UD. These include:
- multiple infections that weaken the uterine wall
- urethral glands that become blocked
- birth defect
- trauma that occurred during childbirth
The symptoms for UD are the same or similar to several other medical conditions. So it isn’t unusual for a proper diagnosis of UD to take some time. You may also be treated unsuccessfully for other conditions before a UD is considered and correctly diagnosed.
To get a correct diagnosis of UD, your doctor may use the following diagnostic tests and exams:
- physical exam
- examination of your health history
- urine tests
- endoscopic exam of the bladder and urethra, which involves placing a thin tube with a camera on the end, called an endoscope, into your bladder and urethra
- MRI scan
- ultrasound scan
Your doctor will start with a physical exam, your health history, and your symptoms. If these show signs that you may have a UD, your doctor will do additional testing and imaging to confirm a diagnosis.
Surgery is the primary treatment for UD. However, you may not want or need surgery initially. You and your doctor may determine that your symptoms and the size of your UD don’t make surgery immediately necessary.
If no surgery is required, your doctor will want to monitor your UD regularly to make sure it isn’t getting larger and to treat your symptoms as they occur. You will also want to monitor your symptoms and inform your doctor of any that are new or are getting worse. Your UD may eventually require surgery, however.
UD is best treated through surgery. Your UD surgery should be performed by an experienced, specialized urologist because it’s an intricate procedure in a sensitive area.
There are three options for UD surgery. These surgery options are:
- cutting open the neck of the UD
- opening the sac permanently into the vagina
- completely removing the UD — most common option, also called diverticulectomy
During surgery, several additional procedures should be done to prevent the UD from returning. These additional procedures include:
- closing the diverticular neck, which connects to the opening of the urethra
- completely removing the lining of the sac
- performing a multilayered closure to keep a new opening from forming later
If you’re having issues with urinary incontinence, your doctor may be able to also correct this during your UD surgery with a procedure that will stop the leaking. Approximately 60 percent of those with UD will also have some type of urinary incontinence.
The recovery from UD surgery usually takes two to three weeks. You’ll need to be on antibiotics for up to a week following surgery. You’ll also have a catheter during the recovery process. This is a tube placed in your bladder to help you urinate. During your follow-up visit several weeks after surgery, your doctor will make sure you are healed before removing your catheter.
During your recovery, you may experience spasms of your bladder. These may cause pain, but it can be treated and managed with medication.
Your doctor will give you a list of activities you should avoid during recovery including a weight limit for lifting, and the amount and type of physical activity you can perform.
At the follow-up visit to your doctor several weeks after your surgery, your doctor will perform a voiding cystourethrogram. This is an X-ray with dye to check for urine leakage. If there is no urine or fluid leaking, your catheter will be removed. If there is leakage, your doctor will repeat this specialized x-ray each week until the leaking has stopped before removing the catheter.
Some issues you may experience following UD surgery are:
- urinary tract infections
- urinary incontinence
- continuance of symptoms
- return of the UD if it wasn’t completely removed
A possible serious complication following UD surgery is a urethrovaginal fistula. This is an abnormal path that is created between the vagina and urethra. This condition will require immediate treatment.
Once your urethral diverticulum is properly diagnosed and treated surgically by an experienced urologist, your outlook is excellent. There are few complications after surgical treatment. Rarely, you may have a recurrence of your UD if it wasn’t completely removed during surgery.
If you and your doctor have determined your UD doesn’t require surgery, you’ll need to treat your symptoms with antibiotics and other treatments as needed. If your infections repeat frequently or your UD becomes larger, your doctor will likely want to move forward with surgical treatment.