Download urethral diverticulum in pregnancy

Abstract No: 91
URETHRAL DIVERTICULUM IN PREGNANCY:
A CASE AND A REVIEW
I. Marcovici
Clinical Assistant Professor, University of Michigan, USA
Case: A 38 years old, G1P0, presented for her prenatal care. On
examination a proximal suburethral mass with a diameter of about 5cm
was found (Fig. 1). The patient was completely asymptomatic and unaware
of its existence. At 36weeks, a cystoscopy showed a normal bladder. The
urethra showed no definite communication in between urethra and
diverticulum. Next, a 5 mm incision was done in the midline through the
vaginal wall into the diverticulum and marsupialization was accomplished.
The patient tolerated well the procedure She remained continent. At 40
weeks delivered vaginally.
Discussion: Female urethral diverticulum is a localized outpouching of the
urethra into the anterior vaginal wall. Its etiology can be acquired,
congenital, iatrogenic. The classical triad of female UD : dribbling of
purulent material, dyspareunia and dysuria is not always present. The
treatment is mainly surgical.
Women with UD are at risk for soft tissue dystocia, and traumatic injury
to the urethra during labor. Medline search for UD in pregnancy,
produced a scarce result: Wittich (1) excised urethral diverticulum calculi
in a symptomatic pregnant women. Allen (2), described a case of pelvic
dystocia secondary to a large urethral diverticulum. Four cases of UD in
pregnancy were presented by Moran (3). They found paraurethral mass in
three patients, urinary incontinence in two, irritative symptoms in two,
urinary tract infection in one. During pregnancy, two of their patients were
treated with antibiotics, two with diverticulum aspiration, and one of them
had incision and drainage.
Two of the women had vaginal delivery and two had Cesarean Sections
for obstetrical indications.
Conclusion: Despite increased awareness in the recent years, Urethral
Diverticulum continue to be overlooked during routine evaluation of
women. A Medline search of urethral diverticulum in women resulted in a
substantial number of articles on the subject. However regarding Urethral
Diverticulum in pregnancy, the result was quite scarce. Therefore, we
believe that our report might benefit the practicing obstetrician.