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Urethral Diverticula Workup

  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Dec 01, 2015
 

Laboratory Studies

See the list below:

  • Urine culture: Obtain urine culture to exclude coexisting urinary tract infection.
  • Fluid culture: When possible, obtain culture of the expressed fluid from the diverticulum so that appropriate antibiotics may be used.
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Imaging Studies

See the list below:

  • Voiding cystourethrography
    • The most helpful plain film radiologic study is a properly performed voiding cystourethrography (VCUG).
    • The study should be performed under fluoroscopic control with the patient sitting or standing in an oblique position.
    • This study aids in defining the location, size, and number of diverticula present.
    • The presence of filling defects within the diverticulum may suggest the possibility of urethral calculi or a tumor.
  • Retrograde urethrography using a double-balloon catheter
    • Retrograde urethrography using a double-balloon catheter may be useful if a suspected diverticulum cannot be observed on a VCUG.
    • This technique has been popular in the past but has fallen out favor because retrograde positive-pressure urethrography is technically difficult to perform and is usually painful. However, this procedure may be performed under general anesthesia, if desired. This procedure has largely been replaced by MRI.
  • MRI: This imaging study has emerged as the criterion standard in diagnostic imaging for urethral diverticula, as it reveals the extent and location of the diverticula. In patients with strongly suspect symptoms, MRI seems to demonstrate the diverticulum with the highest sensitivity and specificity of any of the imaging modalities. Furthermore, planar technology allows the exact ostium to be identified prospectively in many cases and can give the operating surgeon a “roadmap” from which to guide the operative intervention.[5]
  • Intravenous pyelography and CT urography
    • Urethral diverticula have been noted incidentally on intravenous pyelography (IVP) relatively infrequently.
    • Postvoid radiography from an IVP may reveal a collection of contrast below the urinary bladder consistent with urethral diverticulum.
    • While IVP is not recommended as a routine imaging study to document urethral diverticulum, it is useful when ectopic ureterocele is suspected.
    • CT urography may be better since it offers more planes of view; however, no studies to date have confirmed it should be used routinely in the evaluation of suspect diverticula.
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Diagnostic Procedures

See the list below:

  • Urodynamics
    • Consider urodynamic studies in patients with symptoms of stress urinary incontinence or overactive bladder.
    • Patients with overactive bladder may require anticholinergic therapy to control irritative voiding symptoms.
  • Cystoscopy
    • Cystourethroscopy is often performed using a short beaked female urethroscope with a 0° lens. Alternatively, flexible cystoscopy or a urethrotome sheath may be used. Constant water flow and bladder neck occlusion during urethroscopy allows the entire urethra to be distended to enhance visualization.
    • Simultaneous digital compression of the urethral diverticulum may cause active drainage of pus into the urethral lumen, allowing identification of the communication site.
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Contributor Information and Disclosures
Author

Sandip P Vasavada, MD Physician, Associate Professor of Surgery, Cleveland Clinic Lerner College of Medicine, Center for Female Urology and Genitourinary Reconstructive Surgery, The Glickman Urological and Kidney Institute; Joint Appointment with Women's Institute, Cleveland Clinic

Sandip P Vasavada, MD is a member of the following medical societies: American Urological Association, Engineering and Urology Society, American Urogynecologic Society, International Continence Society, Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Allergan and Axonics<br/>Received ownership interest from NDI Medical, LLC for review panel membership; Received consulting fee from allergan for speaking and teaching; Received consulting fee from medtronic for speaking and teaching; Received consulting fee from boston scientific for consulting.

Coauthor(s)

Raymond R Rackley, MD Professor of Surgery, Cleveland Clinic Lerner College of Medicine; Staff Physician, Center for Neurourology, Female Pelvic Health and Female Reconstructive Surgery, Glickman Urological Institute, Cleveland Clinic, Beachwood Family Health Center, and Willoughby Hills Family Health Center; Director, The Urothelial Biology Laboratory, Lerner Research Institute, Cleveland Clinic

Raymond R Rackley, MD is a member of the following medical societies: American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Mark Jeffrey Noble, MD Consulting Staff, Urologic Institute, Cleveland Clinic Foundation

Mark Jeffrey Noble, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, American Urological Association, Kansas Medical Society, Sigma Xi, Society of University Urologists, SWOG

Disclosure: Nothing to disclose.

Chief Editor

Edward David Kim, MD, FACS Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center

Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Allen Donald Seftel, MD Professor of Urology, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School; Head, Division of Urology, Director, Urology Residency Training Program, Cooper University Hospital

Allen Donald Seftel, MD is a member of the following medical societies: American Urological Association

Disclosure: Received consulting fee from lilly for consulting; Received consulting fee from abbott for consulting; Received consulting fee from auxilium for consulting; Received consulting fee from actient for consulting; Received honoraria from journal of urology for board membership; Received consulting fee from endo for consulting.

References
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The urethral diverticulum is shown as spherical mass at the distal urethra.
Voiding cystourethrogram reveals contrast pooling in a urethral diverticulum. The urethral diverticulum is located well away from the bladder neck at the distal urethra.
The anterior vaginal wall and the periurethral fascia have been dissected off, exposing the urethral diverticulum.
The urethral diverticulum has been excised sharply. Foley catheter is visible through the neck of the diverticulum.
The urethral diverticulum is closed in 3 layers with nonoverlapping suture lines. The vaginal wall is closed.
 
 
 
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