Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 6  |  Issue : 4  |  Page : 426-427  

Urethral diverticulum with proximal urethral stricture: An unusual presentation


Department of General Surgery, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra, India

Date of Web Publication17-Sep-2013

Correspondence Address:
Padmanabh Inamdar
Department of General Surgery, Bharati Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-2870.118271

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  Abstract 

Urethral diverticulum with distal stricture is a common entity. We are presenting a rare case of urethral diverticulum with proximal stricture. This is an uncommon case of a 55- year-old male paraplegic patient, who had urethrocutaneous fistula with distal urethral diverticulum and proximal urethral stricture. The patient was successfully managed by single-stage diverticulectomy and urethroplasty.

Keywords: Perineal urethrocutaneous fistula, urethral calculus, urethral diverticulum, urethral stricture


How to cite this article:
Gandhi C, Inamdar P, Prasadi S, Kulkarni S. Urethral diverticulum with proximal urethral stricture: An unusual presentation. Med J DY Patil Univ 2013;6:426-7

How to cite this URL:
Gandhi C, Inamdar P, Prasadi S, Kulkarni S. Urethral diverticulum with proximal urethral stricture: An unusual presentation. Med J DY Patil Univ [serial online] 2013 [cited 2021 Sep 17];6:426-7. Available from: https://www.mjdrdypu.org/text.asp?2013/6/4/426/118271


  Introduction Top


Urethral diverticulum is a common entity in women. [1] The true prevalence of female diverticulum is not known, however urethral diverticulum is reported to occur in up to 1% to 6% of adult women in some series. [2] 10% of urethral diverticuli are congenital and 90% acquired are in posterior urethra. [3] Our male patient had anterior urethral diverticular stone and proximal urethral stricture with fistula. He had recovered from Fournier's Gangrene, a complication of urethral diverticulum.


  Case Report Top


A 55-year-old male with traumatic paraplegia was admitted to our hospital. He was complaining of dribbling of urine since 7 days. On examination he had hard mass felt in the penoscrotal area with fistula over it. He had recovered from Fournier's Gangrene and perineal abscess. All routine investigations were normal.

A kidney, ureter, and bladder (KUB) X-ray showed two stones inside bladder and one stone in urethra distally [Figure 1]. Ascending urethrography showed anterior urethral diverticulum with stricture in proximal membranous urethra [Figure 2].
Figure 1: X-ray KUB showing two stones in bladder and one stone in distal urethra

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Figure 2: Ascending urethrography showing anterior urethral diverticulum with stricture in proximal membranous urethra

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Cystoscopy showed stricture in membranous urethra and opening of diverticulum with a stone in distal bulbar urethra. By cystolithotomy, two stones of size 4 cm and 3 cm respectively were removed. Urethral dilatation was done for stricture followed by bladder catheterization. Tran scrotal urethral diverticulum excision and urethroplasty was done after extraction of the stone (about 3 cm). Suprapubic cystostomy was done for urinary diversion.

Postoperative recovery was uneventful. The patient had good urine flow with healed wounds after 2 years of follow up.

Discussion

Urethral diverticulum is a rare entity in men. 10% of the diverticuli have congenital etiology such as faulty closer of urethral fold's, cystic dilatation of Cowper's duct, or intraspongiosal hematoma. Congenital variety is commonly seen in anterior urethra. Congenital prostatic urethral diverticulum may be remnant of Mullerian duct. Majority (90%) are acquired following trauma due to instrumentation, false passage, or drainage of prostatic abscess, causing suppuration and necrosis of urethral wall and are found in posterior urethra. [4] Other causes of urethral diverticulum are urethral stricture due to foreign-body, infection in periurethral gland, anterior urethral valve, calculosis, syringocoele or Cobb's collar, and hypospadiasis. [5]

Clinically, diverticulum may present as recurrent urinary tract infection, penoscrotal mass in males, [6] or anterior vaginal wall swelling in female. [7] Stone in posterior urethral diverticulum may cause fullness in rectum and straining may cause discharge of pus from urethra. Sometimes it may ulcerate in rectum causing fistula.

Differential diagnosis includes syringocoele, sequestration cyst, epidermoid, and epithelial inclusion cyst. In women, it may have to be differentiated from vaginal leiomyoma, Skene's gland abnormalities, Gartner's duct abnormalities, urethral mucosal prolapse, and carbuncle.

Associated complications are urinary sepsis, phlegmon, urethrocutaneous fistula, calculosis, bladder neck obstruction, septicemia, renal failure, and occasionally malignancy. [8]

Diagnosis is made by ascending urethrography, cystoscopy or micturating cystourethrography, ultrasonography, and magnetic resonance imaging.

Management depends on size of diverticulum.Asymptomatic diverticuli of less than 3 cm size is managed by watchful waiting. If there is stagnation of urine in diverticulum, manual digital compression is advised. Symptomatic diverticuli less than 3 cm with calculus require diverticulotomy and removal of stone. All diverticuli larger than 3 cm require diverticulectomy and urethroplasty. [9]

In authors' opinion, diverticulum distal to stricture is due to altered sensation and impacted stone. In our case, etiology appears to be pressure effect of stone causing wide neck urethral diverticulum. Such type of diverticulum with stricture can be successfully managed operatively by diverticulectomy and urethroplasty in single stage.

 
  References Top

1.Aragona F, Mangano M, Artibani W, Passerini Glazel G. Stone formation in female urethral diverticulum. Review of the literature. Int Urol Nephrol 1989;21:621-5.  Back to cited text no. 1
[PUBMED]    
2.Rovner ES. Bladder and Urethral Diverticula. In: Wein AJ, Kavoussi LR, Novick AC, Edtors. Text book of Campbell's urology, 9 th ed. Philadelphia: Saunders/Elsevier; 2007. p. 2361-90.   Back to cited text no. 2
    
3.Singh I, Neogi S. Male anterior urethral diverticulum with Cobb's collar and a giant stone. J Post grad Med 2006;52:73-4.  Back to cited text no. 3
    
4.Lin TC, Lin YC, Lee SS. Urethral diverticulum in male resulting from blunt trauma: A cause of male urethral calculi. Emerg Med J 2008;25:179.  Back to cited text no. 4
[PUBMED]    
5.Ozgok Y, Seckin B, Demirci S, Harmankaya C, Erduran D, Sinav A. Surgical treatment of urethral diverticuli in male. Scand J Urol Nephrol 1994;28:207-10.  Back to cited text no. 5
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6.Tobe M, Tatsuki J. A case of calculus in male urethral diverticulum. HinyokikaKiyo 2007;53:145-8.  Back to cited text no. 6
    
7.Weng WC, Liu KL, Hong SF, Huange KH. Giant infravesicalstone with recurrent infection. Urology 2009;74:288-9.  Back to cited text no. 7
    
8.Sreedhar K, Singh SK, Mandal AK, Sharma SK. Giant calculus in anterior urethral diverticulum. Urol Int 1992;48:117-9.  Back to cited text no. 8
[PUBMED]    
9.Karanth KS, Yeluri SV, Desai RM, Shah SC. Congenital anterior urethral diverticulum with stone a unique presentation. Urology 2003;61:837.  Back to cited text no. 9
    


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  [Figure 1], [Figure 2]



 

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