Urethral Diverticula in Women

Urethral diverticula are outpouchings from the urethra into the potential space between the urethra and vagina. Infection of Skene glands is thought to play a role in their pathogenesis.

They are seen in up to 40% of women (usually middle-aged) with chronic genitourinary conditions such as recurrent infections, postvoid dribbling, and dyspareunia. 60% may present concomitantly with urinary incontinence, typically due to drainage of the diverticulum causing postvoid dribbling, but stress incontinence can also be seen.

The most common finding is a painful mass in the anterior wall of the vagina that leads to the discharge of urine or purulent material after palpation. The classic clinical triad of dysuria, postvoid dribbling, and dyspareunia, like all such triads, is not common.

Tumors may develop within urethral diverticula, either benign or malignant. Adenocarcinoma is the most common (60% of cases), but transitional cell and squamous cell carcinoma can develop as well.

Voiding cystourethrography will show contrast filling the urethral diverticula if the necks are patent. Ultrasound (transvaginal, transperineal, endorectal, or endourethral) and MRI can also be used.

Differential considerations include:

• Anterior vaginal mass: Müllerian cyst, Gartner duct (typically occur in the anterolateral aspect of the proximal third of the vagina), vaginal epithelial inclusion cyst (commonly located in the lower posterior or lateral vaginal wall at sites of previous trauma), ectopic ureterocele (inserting into the vagina).
• Bartholin gland cyst: Typically located in the posterolateral introitus medial to the labia minora.
• Endometrioma of urethra:
• Urethral neoplasm: Squamous cell carcinoma.

References

• Chang YL, Lin AT, Chen KK. Presentation of female urethral diverticulum is usually not typical. Urol Int. 2008;80(1):41-5.
• Chou CP, Levenson RB, Elsayes KM, Lin YH, Fu TY, Chiu YS, Huang JS, Pan HB. Imaging of female urethral diverticulum: an update. Radiographics. 2008 Nov-Dec;28(7):1917-30.
• Hosseinzadeh K, Furlan A, Torabi M. Pre- and postoperative evaluation of urethral diverticulum. AJR Am J Roentgenol. 2008 Jan;190(1):165-72.