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Year : 2003  |  Volume : 13  |  Issue : 4  |  Page : 441-442
Anterior urethral diverticulum: Report of two cases


Department of Urology, Kmanya Tilak Municipal Edical College And Hospital, Sion, Mumbai- 400022, India

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   Abstract 

Diverticulae of the male urethra are relatively rare entities and review of literature regarding their cause, classification, and management is multifaceted and controversial. Acquired anterior urethral diverticuli without adequate or intact corpus spongiosum and those with well-defined thick walls are best treated oy open surgical techniques. [1] A micturating cystourethrogram (MCU) and ultrasonography (USG) to determine the presence of surrounding tissue (corpus spongiosum) and the wall thickness plays a major role in determining the management. Thin walled and intact diverticula's can be treated by visual urethral urethrotome. [2]

Keywords: Urethral Diverticulum, MCU

How to cite this article:
Trivedi V D, Salve S A, Dangle P, Navale A, Merchant S, Farooq M. Anterior urethral diverticulum: Report of two cases. Indian J Radiol Imaging 2003;13:441-2

How to cite this URL:
Trivedi V D, Salve S A, Dangle P, Navale A, Merchant S, Farooq M. Anterior urethral diverticulum: Report of two cases. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Jul 23];13:441-2. Available from: http://www.ijri.org/text.asp?2003/13/4/441/28730

   Introduction Top


A urethral diverticulum is a tubular or spherical sac like dilatation of the urethra, which is separate from but communicates with the urethra via an ostium. They may be congenital or acquired and occur in males and female.[1]

The two patients in our study had acquired urethral diverticuli. Though the diagnosis is evident on clinical examination, radiology and ultrasound guides the urologist to the correct management options.

It is necessary to determine the thickness, contents of the diverticular sac and see whether it is contained within an intact corpus spongiosum or not. Management depends upon the factors determined by investigations.

CASE 1:

A fifty five year old male with obstructive LUTS for one year presented with swelling on ventral aspect of penile urethra since two months. He had no history of hematuria or pyuria in the past. Urine analysis and culture revealed infection with  Escherichia More Details coli. MCU and USG done revealed meatal stenosis and a thick walled (4 mm) spherical diverticulum not contained in the corpus spongiosum. Cystourethroscopy revealed an unhealthy urethra with BXO but no obvious stricture. The diverticulum was excised in toto and three minute openings in the urethra were closed with vicryl 2-0. SPC was done and post operatively the patient did well.

CASE 2:

Patient was a case of traumatic paraplegia for the last 10 years on per urethral catheter for 10 years, catheter being changed every month. He presented with a history of swelling in the scrotum and pus discharge. There was no history of hematuria. Clinical examination revealed a 5.5 X 3.5 cm mass below penoscrotal angle extruding foul smelling pus on compression. Culture yielded a heavy growth of  Escherichia coli Scientific Name Search e to cefotaxime.

The MCU and USG of the swelling revealed a wide mouth diverticulum at penoscrotal angle and the rest of the urethra was normal. The diverticulum was excised completely, and a single wide (7mm) mouth opening was closed with 4-0 vicryl. The diverticulum was approached by a pararaphal incision. Post operatively SPC was kept. Postoperative recovery was uneventful.


   Discussion Top


Diverticula of the urethra have been classified as congenital and acquired.

Congenital urethral diverticula are rare and situated on the ventral side of the anterior urethra. Pathologically they are lined by mucus membrane similar to that of the urethra and their walls contain a striated muscle layer. [1]

Acquired diverticula are more commonly encountered lesions in men and women and may be due to one of the following etiological causes:

1) Peri urethral suppuration and abscess formation as a sequel of either infection of a paraurethral gland or prostatic abscess or infection of a hematoma.

2) Trauma to the urethra: This may be due to internal injury (instrumental false passage) or external injury causing partial wall rupture.

3) Occasionally it may develop as a pressure effect of an expanding calculus in the urethra with the calculus lying in the periurethral pouch.

4) Neurogenic dysfunction of the urethra in paraplegics is usually secondary to periurethral infection and abscess formation following trauma from instrumentation or indwelling catheter.

5) Bilharziasis of the urethra is common in Egypt, secondary to periurethral suppuration.

Acquired diverticula can occur anywhere in the anterior or posterior urethra. They are lined by septic granulation tissue or fibrous tissue devoid of muscle fibers.[1]

Diagnosis of anterior urethral diverticulum is usually possible clinically. Smaller diverticula are silent. As they increase in size there may be involuntary dribbling of urine on movement or pressure as the course progresses they become palpable and visible. If infected there will be, recurrent attacks of pain in the pouch with dysuria and blood stained pus discharge. A urethral stone is characterized by being a hard fixed mass that cannot be evacuated on pressure.

MCU:

The urethral diverticula are sometimes filled with opacified urine during voiding at urography and thus diagnosed on the post-voiding radiograph. However they often fail to "fill" at urographic study, in which case the diagnosis can be made by retrograde urethrography; cystoscopy and urethroscopy often fail to demonstrate the diverticula. Positive pressure retrograde urethrography can usually demonstrate the diverticula, but the technique may be difficult.[3]

USG:

Sonography has been used for evaluation of traumatic urethral diverticula. Gray scale ultrasound is done by placing an 8 MHz linear array probe on the penile shaft at penoscrotal junction. Urethral diverticula appear as fluid filled outpouchings adjacent to the urethra. Those diverticula that do not fill on retrograde urethrography can be seen sonographically.

Sonourethrography is done by injecting 25 cc of saline via an infant feeding tube through the urethra while scanning anteriorly shows the fluid passing through the urethra via an opening into the diverculum. Detailed anatomy and pathology of the diverticulum namely its relation to the urethra, its size, its neck (broad/narrow) presence of echoes etc can be visualized. [4]

 
   References Top

1.Ortlip S.A., Gonzales R, and Williams R.D.-Diverticula of male urethra. J Urol 1979; 124: 350-355  Back to cited text no. 1    
2.Mahony, D.T.: Studies of enuresis. II A new valvotome for the endoscopic surgical treatment of congenital valvular obstruction of urethra. J Urol 1972; 107: 318  Back to cited text no. 2    
3.Davis H.J and Telinde, R.W.urethral diverticula: an assay of 121 cases .J Urol 1958; 80:34  Back to cited text no. 3    
4.Gluck CD, Bundy AL, Fine C, et al Sonographic urethrogram: a composition to roentgenographic techniques in 22 patients. J Urol 1988; 140:1404-1408  Back to cited text no. 4    

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Correspondence Address:
V D Trivedi
Department of Urology, Kmanya Tilak Municipal Edical College And Hospital, Sion, Mumbai-400022, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


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