Female urethral diverticulum containing a urothelial carcinoma

Female urethral diverticulum containing a urothelial carcinoma Dear Editor, We report the case of a 63-year-old black female who presented with complaints of difficulty in urinating and pollakiuria. She also reported an eight-month history of episodes of dysuria and hematuria. She had smoked for 10 years and had quit 30 years prior. She had three pregnancies, all with vaginal delivery, and had undergone total hysterectomy 17 years prior. Magnetic resonance imaging (MRI) of the pelvis revealed, below the urinary bladder, a cystic formation involving the ure-thra, consistent with urethral diverticulum (UD), within which there was a solid component showing paramagnetic contrast enhancement , suggesting an expansive process. Communication with the urethra was well defined after a urethral catheter had been inserted. The diverticulum was surgically resected. On the basis of histological and immunohistochemical studies of the surgical sample, the patient was diagnosed with papillary urothelial diver-ticular carcinoma. The reported prevalence of UD is 0.6–6.0%, and the condition is most common in women between 30 and 60 years of age (1– 8). Some studies have reported that the incidence of UD is higher in black individuals (3,4,7). Typically, UD is underdiagnosed because, in most cases, the clinical profile is nonspecific (2,4–6) and up to 20% of patients are asymptomatic (4,8). The site most often affected is the middle third of the urethra, where the paraurethral glands (Skene's glands) are typically located, and 96% of diverticular orifices are posterolateral (1–5,8). Most patients with UD have the acquired form, which probably arises from dilation/abscess in parau-rethral glands. Other causes include trauma and surgery (1–5,8). Typically measuring 0.2–1.6 cm (5) , UDs can be single or multiple , simple or multiloculated, and locally restricted or surrounding the urethra (in a " horseshoe " shape), with one or more (narrow or broad) orifices (1,2). Differential diagnoses include cervical cysts, vaginal cysts, abscesses, tumors, urethral endometriosis, and ectopic ureterocele (2,4,5). Clinical findings include the classic triad of dysuria (in 30– 70% of cases), dyspareunia (in 10–25%) and postmicturition dribble (in 10–30%), as well as pollakiuria or urinary urgency (in 40–100%), urinary incontinence (in 32–60%), recurrent urinary tract infections (in 30–50%), hematuria (10–25%), and bulging in the anterior vaginal wall (in 35%), accompanied by purulent urethral discharge on palpation (in 12%) (1–8). The chronic inflammation and urinary stasis seen in UDs result in complications (3,4) , including calculi (in 1.5–10%) and malignant tumors (1–8). As for the …