Urethral diverticulum: a potential hazard of penile clamp application for male urinary incontinence.

To cite: Kalra S, Srinivas PR, Manikandan R, et al. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2015209957 DESCRIPTION Urinary incontinence is a common problem encountered after prostatectomy. After a trial of conservative management, men are generally left with a choice of surgery, drainage or absorbent devices, or a penile compression device. Artificial urinary sphincter is the current gold standard for management of post-prostatectomy incontinence with acceptable long-term success rates. However, in patients who are not fit to undergo another surgery or cannot afford these devices, especially in developing countries, penile compression devices come in handy. Use of these devices has been shown to cause a significant reduction in Incontinence Impact Questionnaire scores in different studies. However, these devices have the risk of complications such as pain, urethral erosion, obstruction and oedema, with long-term use. It is recommended to de-clamp these devices at a regular interval of 4 h. We encountered a potential hazard from a penile compression device in the form of anterior urethral diverticulum. A 70-year-old man presented to our department with a history of painless progressively increasing swelling at the penoscrotal region for the past 2 years. He had been using a penile compression device for the past 6 years for postprostatectomy incontinence (figure 1). A micturating cystourethrogram showed an anterior urethral diverticulum (figure 2), which was confirmed on urethroscopy (figure 3). The possible aetiopathogenesis for the diverticulum, in this case, could be prolonged application of a penile clamp resulting in urinary stasis and increased urethral pressure. Increased urethral pressure can lead to infection and eventual suppuration of the periurethral glands. An alternative reason suggested for such an occurrence is necrosis of the urethral epithelium and subsequent urinary extravasation leading to a periurethral abscess and diverticulum formation. Also, a history of instrumentation and previous catheterisation are risk factors for acquiring urethral diverticulum. The patient was managed with a diverticulectomy with urethral reconstruction and placement of a male urethral sling for incontinence.