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Urethral diverticulum

Urethral diverticulum (UD)is a condition in which “pockets” form on the urethra the tube carrying urine out of the body.These pockets can be of varying sizes and become filled with urine as these pockets cannot empty during voiding they can result in repeated infections,dribbling and pain during during sexual intercourse.

Normally affecting women between the ages of 30-60 Urethral diverticulum is more common in African women it is also much more common in women than in men.

Urethral diverticulum is often linked to repeated infections and /or the obstruction of the periuethral glands.Urethral diverticulum may also be caused by trauma experienced during childbirth

Many of the symptoms associated with urethral diverticulum are non-specific and mistaken for other conditions .This means that patients are often misdiagnosed and do not receive the effective treatment that is available for many years.
Most patients had been treated for cystitis,bladder overactivity,incontinence,interstitial cystitis and pelvic pain syndrome before the correct diagnosis is made.

By taking a thorough history with a high index of awareness,endoscopic examination of the bladder and urethra, specialised MRI imaging and using the latest video urodynamics to assess urethan and bladder function early diagnosis and effective treatment can be offered.

Although often highly symptomatic not all urethral diverticula require surgical removal.For patients without problematic symptoms surgery may not be required. It is not clear which untreated urethral diverticula will grow in size or if symptoms will increase over time.Some patients without problematic symptoms may prefer to continue with ongoing monitoring and to defer surgery until such a time that the symptoms become problematic for them.

Surgical excision of the urethan diverticular is the preferred option for symptomatic patients but should be performed with cautation.This can be a very complex procedure and should only be performed by specialist with experience in this type of surgery.The diverticula sac can be firmly attached to the urethra inexperienced removal of the sac may result in large urethral defect resulting in incontinence.
It is very important that the whole lining of the urethral diverticulum is removed to prevent recurrence and to ensure that the neck of diverticulum is closed in such a way to prevent postoperative urethrovaginal fistula formation. (formation of opening between the urethra and vagina)

Jeremy Ockrim is one of three sub specialist Urologists performing urethral diverticular surgery at the Institute of Urology,University College Hospital London.He recently published the groups results of 30 urethral diverticulum procedures, the biggest series reported in the united kingdom in over 20 years.