Acute urinary retention in a woman due to large urethral diverticulum: A case report

Introduction:

The diverticulum of the female urethra is a sac-like protrusion of the urethral mucosa into the adjacent tissue. The classic clinical presentation includes the ‘three Ds’: post-void dribbling, dyspareunia and dysuria. However, these symptoms are rarely encountered. The diverticula affect 0.02%–6% of women worldwide and they are presented between 30 and 60 years old, with a mean age of diagnosis of 36 years. The aim is to present a rare case of acute urinary retention due to a large urethral diverticulum. According to the literature review, no similar case has been reported since 2000.

Materials & Methods:

A 47-year-old woman with an unremarkable past medical history and one childbirth presented to the Emergency Department with acute urinary retention. The physical examination revealed a palpable, mobile, soft mass in the anterior vaginal wall. The urodynamic study demonstrated voiding dysfunction due to bladder outlet obstruction. A T2-weighted pelvic MRI showed a contrast-enhanced large (4 × 3, 1 centimeters), horseshoe, cystic mass, that surrounded the urethra. During rigid cystourethroscopy, the ostium of the diverticulum was identified in the left lateral wall (4 o’clock) of the anterior urethra.

Results:

The patient underwent transvaginal diverticulectomy and reconstruction of the urethra. The postoperative course was uneventful and she was discharged on postoperative day 2. The urethral catheter was removed at the postoperative week 3 and the patient voided successfully.

Conclusions:

Due to the variety of symptoms, the diagnosis is difficult and a high index of suspicion is frequently required. In the majority of cases the investigation is based on imaging and MRI is considered the imaging test of choice. The natural evolution of asymptomatic diverticula left untreated remains unknown, but complications such as carcinogenesis and stone formation have been reported.