A ring-shaped stone in a female urethral diverticulum: case report and review of literature

The classic presentation of urethra diverticula has been described historically as the "3 Ds," meaning dysuria, dyspareunia, and dribbling. As the symptoms are not specific, urethral diverticulum may often be misdiagnosed. We report a case of a ring-shaped stone in a female urethral diverticulum, which was successfully treated surgically.     

Stone formation in a female urethral diverticulum Review of the literature

A case of stone formation within a female urethral diverticulum is presented together with a brief literature review. Clinical diagnosis may be suspected if a stony hard mass is palpable on the floor of the urethra. The definitive diagnosis depends upon a plain X-ray film and a retrograde positive pressure urethrogram. Surgical excision of the diverticulum together with the calculus is best performed by the vaginal route.     

Giant lithiasis in a female urethral diverticulum

The formation of gallstones in a urethral diverticulum is a rare clinical entity and is usually seen in males. The case of a 50 year old woman is presented, who consults for hard vaginal mass and dispareunia associated with repeated urinary infections, with radiological images and an interesting photoendoscopic vision of the upper dome of the gallstone. The diverticulum was approached via vaginal way and the local extraction was successful.     

Adenocarcinoma in a female urethral diverticulum.

Carcinoma occurring within a diverticulum of the female urethra is an exceedingly rare disease for which the treatment is ill-defined. We present here the first reported case of this condition from Australasia and review some of the recommendations for treatment.     

Calculi in female urethral diverticulum

A case of two calculi found in the same urethral diverticulum in a 41-year-old woman with recurrent urinary tract infections is reported. The diagnostic procedures are discussed.     

Diagnosis and management of female urethral diverticulum

Female urethral diverticulum is a disorder that affects 1% to 6% of women. Women with diverticula may present with a variety of nonspecific genitourinary complaints, making the diagnosis challenging. Diagnosis is made by physical examination and can be confirmed with cystourethroscopy and/or radiographic imaging. Asymptomatic women can be managed conservatively, whereas treatment for symptomatic women usually involves a diverticulectomy. Potential complications from diverticulectomy include diverticulum recurrence, de novo stress incontinence, urethrovaginal fistula, urethral stricture, and recurrent urinary tract infections. This article reviews the etiology, differential diagnoses, evaluation, and management of female urethral diverticula.     

Evaluation and management of female urethral diverticulum

The urethral diverticulum has many varied presentations; therefore, ultimate diagnosis may be difficult. Until recently, radiographic evaluation was difficult to perform, was uncomfortable for the patient, and had poor sensitivity. The increasingly widespread use of magnetic resonance imaging coupled with heightened awareness of the problem has enhanced the overall detection of urethral diverticula. Management is still primarily surgical and entails proper anatomical identification of the defects that cause the diverticulum, so subsequent reconstruction can be performed easily and with minimal morbidity.     

Clear cell adenocarcinoma in a female urethral diverticulum

Primary urethral carcinoma is an uncommon diagnosis, and carcinomas arising from within a urethral diverticulum are rare. Because of the limited number of diagnosed cases, optimal treatment guidelines are not available. However, patients require an aggressive treatment approach to provide the best chance for cure.     

Clear cell adenocarcinoma in a female urethral diverticulum

The incidence of a neoplasm within the female urethral diverticulum is rare. Clear cell adenocarcinoma, which is the most common neoplasm, arises from the metaplasia of surface transitional epithelium and the paraurethral ducts. These tumors are usually diagnosed at a late stage, which worsens their prognosis. The treatment of choice is surgery.     

Squamous cell carcinoma in a female urethral diverticulum

A 38-year-old woman was found to have a squamous cell carcinoma in a urethral diverticulum after a simple diverticulectomy. The aggressiveness of this histologic subtype of carcinoma, along with this patient's long life expectancy, supported the choice of aggressive therapy. Only nine other cases have been reported. A brief review of the published reports on the presentation, diagnosis, options for treatment, and outcomes is included.     

Adenocarcinoma arising in female urethral diverticulum

Cancer arising from a female urethral diverticulum is rare, and because of its rarity, a review of the medical literature reveals significant nonuniformity in its management. We report an additional 2 cases of this disease, one of which has an even rarer feature of being mucin-producing. The management of our 2 cases is presented in detail and in line with the management of female urethral cancer. From our extensive literature search, diverticulectomy alone showed poor results with the highest rate of recurrence (67%). Extensive surgery, either in the form of cystourethrectomy or anterior exenteration, offered results comparable with those of combined therapy (diverticulectomy and full course of irradiation for early cases; preoperative irradiation followed by cystourethrectomy for late cases). Individualization of radiation treatment and cooperative effort between urologist and radiation oncologist are essential if best results are to be achieved.     

Giant accessory female phallic urethral diverticulum

Anomalies of the urogenital sinus have been described in association with male pseudohermaphroditism, bladder and uterine duplication, and a spectrum of external genital anomalies, including a female phallic urethra. The evaluation and optimal surgical management of these anomalies can be complex. We describe a case of a female patient with an accessory phallic urethra and a urogenital sinus anomaly. The presence of stenosis of the accessory urethral meatus led to the formation of a giant diverticulum with unusual features. The complete repair of the anomaly incorporated creation of labia minora from portions of the diverticulum.     

A case of female urethral diverticulum calculi

A 53-year-old nulliparous woman complained of terminal pain on urination and bended micturition. Previously, she had been treated unsuccessfully with antibiotics for chronic cystitis. On examination, a mass of approximately a thumb's head-size, was palpated at the left portion of urethral meatus. Plain film of the pelvis revealed stones under the margin of symphysis pubis. Positive pressure urethrography revealed a diverticulum slightly larger than the stones. Transvestibular diverticulectomy and urethrolithotomy were performed without any postoperative complications. In Japan, 38 cases of diverticulum calculi of the female urethra have been reported.     

Urinary retention caused by female urethral diverticulum

We report a 49-year-old female who had circumferential urethral diverticulum. She was admitted to our department for urinary retention. A cystic lesion surrounding the urethra had been detected by magnetic resonance imaging. We diagnosed the lesion as a urethral diverticulum after injecting dye to the cystic mass from vagina and confirming its discharge from the urethra at the pubic side by urethroscopy. Transvaginal resection of the diverticulum was peformed. In general, 4% of female urethral diverticula cause urinary retention. On the other hand, 1% of female bladder outlet obstruction is caused by urethral diverticula. It is neccessary for us to keep in mind urethral diverticulum when we evaluate female patients with urinary retention.     

Contemporary evaluation and management of the female urethral diverticulum

We are in agreement with Davis and Telinde, who state, "The most important single diagnostic instrument for the discovery of suburethral diverticula is the high index of suspicion" [25]. The key to successful treatment of a female diverticulum is not only in the surgical management but also in the identification and evaluation of patients who present with a myriad of symptoms. It is our responsibility to include urethral diverticula in the differential diagnoses before the labels of interstitial cystitis, urethral syndrome, or urgency frequency syndrome are misplaced. The diagnosis may be elusive and the pathology difficult to identify on physical examination. However, if the index of suspicion is high and the proper radiologic imaging studies are gathered, then the correct diagnosis will often be made. The evaluation of the female urethral diverticulum has evolved greatly over the past several years. However, once appropriate diagnosis is made, the management scheme is fairly straightforward. Strict adherence to principles of surgical reconstruction allows one to eradicate the diverticulum while simultaneously preventing complications and recurrences.     

女性尿道憩室外文文献计量分析

目的提高女性尿道憩室的临床认知度。方法应用国外数据库PubMed检索近十年内有关女性尿道憩室的所有文献,采用文献定性/定量分析方法,对国外有关女性尿道憩室的论文各个方面进行整理和数据评价分析。结果相关论文共计37篇,有效病例数375例。对所有患者描述的相关症状及体征进行归纳分析显示,国外患者临床表现多是排尿困难及尿失禁。在我国相关文献报道中,诊断女性尿道憩室主要体征为阴道肿物以及挤压尿道后有液体从尿道流出,而在外文中女性尿道憩室的挤压征未有详细描述。所有病例均予以实施外科手术切除憩室治疗,无统一术式,疗效均可。对国内外患者临床症状进行对比分析,排尿困难症状两者差异无统计学意义(P>0.05),尿失禁症状两者差异有统计学意义(P<0.05)。结论女性尿道憩室发病率存在争议,临床表现不具有特异性,可合并结石和尿失禁等,并存在癌变可能,需要提高临床重视程度,同时需要临床工作者重视临床研究,才能提高临床诊断治疗水平,降低漏诊、误诊率。     

A case of adenocarcinoma in female urethral diverticulum

A 49-year-old woman presented with complaints of dysuria and gross hematuria. Vaginal examination revealed an elastic-soft mass beneath the anterior vaginal wall. Urine cytology was positive. Urethrocystoscopy, magnetic resonance imaging and computed tomographic scan revealed a localized urethral diverticular tumor. Transurethral resection of the tumor was performed and the histopathologic finding was adenocarcinoma. Transvaginal urethral diverticulectomy was performed. Histopathological examination showed that the tumor arose in the urethral diverticulum and the proximal margin was positive. She had local recurrence at six months after the operation, and cystourethrectomy was performed. Six months after the operation, she had no evidence of recurrence. We review 18 cases of urethral diverticular carcinoma in Japan.