Presented by: Ben Sionov MD
Urologic surgery, Wolfson Medical Centre, Holon , Israel

Introduction

The Incidence of urethral diverticula varies between 0.02-6%. The natural history of the condition remains unclear. There is no consensus regarding who are the patients that should be offered surgical treatment and what is the right timing. Nowadays, most of the patients diagnosed with urethral diverticula will be offered surgical treatment, even if asymptomatic. 

This study aimed to evaluate the natural history of the condition in women diagnosed with urethral diverticula, not treated surgically due to various reasons. 

Materials

Retrospective analysis of the database was performed. Patients with paraurethral masses were included. 126 patients answered the inclusion criteria. Demographic, clinical data, physical examination, imaging, type of treatment and the results were analyzed, in addition a telephonic survey was performed. 

Results

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99 women were diagnosed with urethral diverticula, of them 21 women aged between 18 to 52 (average 35.8) years old were not treated surgically following the initial diagnosis. Of those, 11 patients had symptoms (group 1), while 10 were asymptomatic (group 2). 

Of the symptomatic patients (group 1) 4 underwent puncture and drainage of the content, 5 had spontaneous drainage. Five women (45%) underwent surgery later in life (from 1 to 20 years). In the asymptomatic patients (group 2) one patient had spontaneous drainage of the mass, with no recurrence. Only one patient (10%) underwent surgery to remove the diverticula. One patient was lost to follow up. 

Overall, in the study group, 28.5% of patients underwent surgery following conservative therapy, not as initial management option, of them 45% were symptomatic and 10% asymptomatic. 

Conclusion

Most of the patients with asymptomatic urethral diverticula will benefit from conservative treatment/ observation alone. 

Following spontaneous drainage regression of the mass is possible, therefore, offering them conservative treatment is a reasonable option. 

In our opinion, the natural history of the condition suggests we are in presence of periurethral retention cyst, and not diverticula.

Funding

None

Lead Authors

Masha Ben Zvi, MD
Obstetrics and Gynaecology, Wolfson Medical Centre, Holon , Israel

Alexander Tsivian, MD
Urologic surgery, Wolfson Medical Centre, Holon , Israel