Female Urethral Diverticula: A Review of the Literature

Background: Female urethral diverticulum is a condition which is often overlooked and frequently misdiagnosed. It is hoped that as a result of greater awareness of female urethral diverticulum more timely diagnosis of the condition would be made which would result in early appropriate treatment. Objective: The objective of this review is to summarize the presentation, investigation and management of female urethral diverticulum. Result of the Literature Review: Urethral diverticula are more common than is currently being diagnosed. The presenting symptoms can be summarized as Dysuria, post-micturition Dribbling and Dysparaeunia (‘the three Ds’). Patients may also present with other types of lower urinary tract symptoms. More than half of the cases of female urethral diverticula may be palpable on examination. With regard to investigation, traditional contrast studies are currently being replaced by advancedimaging procedures including magnetic resonance imaging, and virtual computed tomography urethroscopy. These imaging modalities depict a much greater and better tissue definition; only few studies have directly compared the contrast-based investigative procedures, the various ultrasonography techniques, and cross sectional imaging modalities that are avai lable. With regard to treatment smal l asymptomatic female urethral diverticula may not require treatment. There are three options of surgical treatment for urethral diverticulum and these include: 1. Trans-urethral incis ion of the urethral communication, thus transforming a narrow diverticulum into a wide-mouthed diverticulum. 2. Marsupialization of the diverticulum sac into the vagina by incising the urethro-vaginal septum. 3. Diverticulectomy with or without a reconstructive surgery. Delay in the diagnosis of female urethral diverticulum can have a significant impact on a patient’s outcome. Patients with a delayed diagnosis (over 12 months) have been found to be at high risk of developing postoperative complications. More worryingly, high recurrence rate after surgery and early metastases is the unfortunate outcome of delayed diagnosis of diverticula-neoplasms. Conclusions: Female urethral diverticulum is eminently treatable but there is little standardization of this condition. The greatest single improvement in the management of female urethral diverticulum would emanate from more widespread clinical awareness of the condition and its presentation and the fact that all available investigations when used as a result of increased awareness of the condition would lead to early diagnosis and appropriate early treatment. Delay in the diagnosis of female urethral diverticulum can have a significant impact on a patient’s outcome. Patients with a delayed diagnosis (over 12 months) have been found to be at high risk of developing postoperative complications. Therefore, by being more aware of urethral diverticulum as a differential diagnosis, clinicians may be able to reduce this delay and the complications that can occur with the condition.