Urethral diverticular with broadly squamous metaplasia in a patient with urethral diverticular calculi: A case report

RATIONALE

There are already several reports concerning the occurrence of urethral diverticulum (UD) in female patients, but only rarely has a article describing UD combined with UD calculi or squamous carcinoma been published. Moreover, a case with squamous carcinoma and UD calculi at the same time has never been reported, making this the first case report about this condition.

PATIENT CONCERNS

A 43-year-old woman presented to the gynaecology department with a complaint of a hard mass beneath the anterior vaginal wall.

DIAGNOSES

Transvaginal ultrasound (TVU) revealed a UD.

INTERVENTIONS

We performed a standard urethral diverticular excision. Intraoperatively, we identified and removed a stone from the diverticulum. The intraoperative finding of a stone challenged the diagnosis of UD, with subsequent histological examination of biopsy tissue from the mass demonstrating broadly squamous metaplasia.

OUTCOMES

The broadly squamous metaplasia predominantly originated from the stone, and the stone was entirely removed. No complications occurred during the whole follow-up period. Moreover, after the 12-month follow-up, there was no diverticular recurrence or carcinoma metastasis.

LESSONS

UD calculi may be considered a risk factor for female urethra squamous metaplasia, which with the potential of squamous carcinoma, so patients will be advised to treat this condition immediately.

Female Urethral Diverticula: Diagnosis, Pathology, and Surgical Outcomes at an Academic, Urban Medical Center

OBJECTIVE

To describe the outcomes of a series of women diagnosed with a urethral diverticulum at an urban tertiary care center.

METHODS

An Institutional Review Board-approved review of a series of 78 women with a diagnosis of urethral diverticulum from 2009 to 2015 was performed. Clinical, radiographic, and pathologic data was collected by retrospective review of patient medical records. Data regarding treatment selection and postoperative outcomes were collected. A multivariable logistic regression was performed to identify preoperative variables that were associated with undergoing surgical resection.

RESULTS

Of the 78 patients reviewed, the median age was 45.5 years (interquartile range (IQR) 36.0-53.8), median body mass index was 30.4 (IQR 24.8-34.4). The most common presenting symptoms included: incontinence (39%), recurrent urinary tract infections (23%), dysuria (18%), discharge (13%), dyspareunia (12%), and hematuria (9%). Additionally, 16 (21%) women were asymptomatic. Of these 78 cases, 40 underwent surgical excision (51%). Of the remaining 38, 13 were symptomatic and lost to follow-up, 23 were managed expectantly, and 2 underwent surgery after the study period. Review of the pathology results revealed that the most common finding was squamous metaplasia (31%). There was 1 adenocarcinoma in the series (2.5%). Of the 40 patients who had surgery, 3 (7.5%) had a diverticular recurrence and 5 (12.5%) developed stress urinary incontinence. The median follow-up was 7.5 months (IQR 1-20.25 months).

CONCLUSION

A variety of presenting symptoms existed for women with a urethral diverticulum seeking medical care at an urban medical center. When controlling for age, body mass index, and race, the presence of preoperative symptoms was associated with undergoing surgical resection.

A Case of Urethral Diverticulum with Surgical Repair Using Cadaveric Pericardial Tissue

A urethral diverticulum is a relatively uncommon finding. The estimated prevalence is approximately 1-5% in the general population. While the definitive treatment is surgical correction, there are limited studies guiding the best approach to repair. This is the case of a 48-year-old female who initially presented with vaginal discharge, dysuria, and dyspareunia. MRI revealed the diagnosis of suspected urethral diverticulum. The patient was treated with surgical correction with the aid of needle localization prior to the procedure. After the diverticulum was excised, the resulting defect in the urethra was successfully closed with cadaveric pericardial tissue. A urethral diverticulum should be considered in the differential diagnosis when a patient presents with symptoms such as recurrent urinary tract infections (UTIs) vaginal mass, dysuria, dyspareunia, or vaginal discharge. The use of cadaveric tissue augments the surgical technique for repair.

Female urethral diverticula: An elusive pathology that can cause significant problems

Female urethral diverticula are a rare pathology, although thought to be under-diagnosed. They can present with a large variety of symptoms, and can be complicated by stones or malignancy. Magnetic resonance imaging is widely accepted to be the best form of imaging for this condition, although voiding cystourethrogram studies are helpful in providing information on bladder function. Symptomatic patients should be treated surgically through urethral diverticulectomy.

Level of evidence: Not applicable for this multicentre audit.

Pelvic floor ultrasound in incontinence: what's in it for the surgeon?

There is increasing interest in imaging techniques such as magnetic resonance and ultrasound amongst pelvic floor surgeons, as evidenced by the number of workshops and conference presentations in this field. Ultrasound is employed more commonly, due to much lower costs, greater accessibility and practicability. Consequently, this review focuses on sonography. At this time, imaging is probably under-utilised in urogynaecology and female urology, although it has the potential to greatly benefit our patients. In this review, I will outline the main uses of imaging in the work-up of women with urinary incontinence, before and after treatment, and focus on areas in which this benefit to patients and clinicians is most evident.