Diverticula of the female urethra

Objective. To determine the optimum procedure for the diagnosis and therapy of diverticula of the female urethra. Patients and methods. The study included 18 patients with urethral diverticula treated at the Cristo Re Hospital in Rome between 1987 and 1995. Most of the patients were suffering from cystitis (eight), dysuria (seven) and recurring urinary infections (11). Less frequently, more specific symptoms were present such as post-voiding dribbling (two) and anterior vaginal mass (three). The pre-operative evaluation included a history, physical examination, voiding and positive pressure voiding cysto-urethrography (VCUG) and urodynamic tests. A 'typical' surgical excision of the diverticula was carried out in all cases. Surgical excision was combined with cystopexis (Raz operation) in four patients with urinary stress incontinence and three with detrusor instability were treated postoperatively with anticholinergics for 3 months. The outcome was evaluated by a physical examination and urodynamic tests at 3, 6 and 12 months postoperatively; the mean (range) follow-up was 34 (2-80) months. Results. All the urethral diverticula were in the distal two-thirds of the urethra, along the posterolateral wall. The VCUG was sufficient for diagnosis in eight patients while the other 10 required a positive-pressure VCUG. Fifteen patients were evaluated; complications included a urinary tract infection for 2 months in four patients and stress incontinence for 2 months in two. There were no recurrences or urethrovaginal fistulae. Conclusions. Diverticula in the female urethra are difficult to diagnose because the symptoms can be misleading; the positive-pressure VCUG is useful in doubtful cases. However, a detailed history and physical examination are mandatory.