Nephrogenic adenoma in urethral diverticulum in a woman

Nephrogenic adenoma in a urethral diverticulum

Nephrogenic adenoma (NA) is a rare finding that represents metaplasia of the urothelium. We present a case of a 46-year-old woman who presented with a symptomatic anterior vaginal wall cyst that was found to be an NA within a urethral diverticulum. Although this remains an infrequently reported entity in the literature, prevalence has been shown to be higher in consecutive case series than what may be presumed by the rarity of case reports in clinical literature. Nephrogenic adenoma within a urethral diverticulum may represent an under-recognized entity which needs to be carefully distinguished from clear cell adenocarcinoma occurring within urethral diverticula. We discuss salient clinical features of NA occurring within a urethral diverticulum and describe a review of literature of published cases to date.

Female urethral diverticula

Urethral diverticula are frequently under-diagnosed. The pathogenesis of this condition is poorly understood, and these lesions represent a spectrum of disorders ranging from isolated suburethral cysts to herniation of the urethral lining into the vaginal mucosa. Women with this disorder frequently complain of a host of symptoms referable to the lower urinary and genital tracts. Accurate diagnosis is based on history and clinical evaluation. Perineal ultrasound and MRI are often helpful. Repeated courses of antibiotics and urethral dilatation often fail to resolve the problem, and definitive intervention usually requires surgical excision to provide relief. This chapter describes the current management of this condition, and it heralds a re-look at the patho-aetiology in view of recent MRI findings of symptomatic non-communicating microcystic lesions.

Transrectal ultrasonography in the diagnosis of urethral diverticula in women

The diagnosis of urethral diverticula in women can be difficult. Several imaging modalities have been described for evaluating this entity: urethrography; transabdominal, transrectal, transvaginal, and transperineal ultrasonography; computed tomography (CT); and magnetic resonance (MR) can be helpful in evaluating a diverticulum and its relationship to the urethra. We report on four women aged 36 to 42 years with urethral diverticula. Transrectal ultrasonography (TRU) was the most useful diagnostic test in our series. TRU showed 7 urethral diverticula and provided information about its shape, volume, and content as well as its spatial relationship about its shape, volume, and content as well as its spatial relationship to the urethra. In two cases, multiple diverticula were detected when only a single lesion was clinically suspected. Transabdominal sonography failed to demonstrate small diverticula. CT examination did not provide additional information except for the passage of the contrast from the urethra to the diverticulum in one of the cases. Voiding cystourethrogram was positive in only one patient.