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Urethral diverticula in women

Nature Reviews Urology volume 12, pages 671–680 (2015)Cite this article

Subjects

Key Points

  • Urethral diverticula are rare outpouchings of the female urethra

  • Urethral diverticula occur most commonly in parous women aged 30–60 years

  • The most common presenting symptom is urinary incontinence

  • Diagnosis is best achieved by clinical examination, T2-weighted MRI of the pelvis and videocystometrography

  • The most effective treatment is vaginal surgical excision

Abstract

Female urethral diverticula are rare, benign epithelium-lined outpouchings of the female urethra. Patients can present with a multitude of symptoms, most commonly urinary incontinence, recurrent UTIs and dyspareunia. These presenting symptoms are often confused with other diagnoses leading to delayed diagnosis or misdiagnosis. Diagnosis and preoperative assessment of bladder function is most accurate using a combination of clinical examination, T2-weighted postvoid MRI and videocystometrography. Best treatment is by vaginal excision, a procedure with a very low recurrence rate and high patient acceptability. Excision also results in high cure rates for associated dyspareunia, UTI and voiding dysfunction. Pre-existing urodynamically proven stress urinary incontinence (USUI) resolves in 50% of patients after excision of the diverticulum with Martius labial fat pad interposition without the need for further treatment. Potential adverse effects after surgery are new-onset USUI, urethrovaginal fistula and urethral stricture. The rate of onset of these potential adverse effects is low and related to the preoperative appearance of the diverticulum on an MRI scan and the complexity of the diverticulum.

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Figure 1: The anatomy of the urethra.
Figure 2: The anatomy of the periurethral glands and the paraurethral glands of Skene in relation to the bladder and urethra in women.
Figure 3
Figure 4: A videocystometrograph for diagnosis of a urethral diverticulum.
Figure 5: A urethral diverticulum on T2-MRI transverse section.
Figure 6
Figure 7: Operative excision of a urethral diverticulum with a Martius fat pad interposition.

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  1. Department of Urology, University College London Hospital, Ground Floor North, 250 Euston Road, London, NW1 2PG, UK

    Tamsin J. Greenwell & Marco Spilotros

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Greenwell, T., Spilotros, M. Urethral diverticula in women. Nat Rev Urol 12, 671–680 (2015). https://doi.org/10.1038/nrurol.2015.230

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