Clear cell carcinoma in a urethral diverticulum

A 54-year-old female presented with a long history of multi-drug-resistant urinary tract infections, urinary urgency and frequency, haematuria, stress urinary incontinence and difficulty voiding. Examination revealed a large, hard anterior vaginal wall mass with purulent discharge. Investigation with MRI demonstrated a complex urethral diverticulum containing stones with fistulation into the vagina. Drainage of the abscess and excision biopsy of the diverticulum revealed clear cell carcinoma. She therefore underwent completion urethrectomy, bladder neck closure and Yang-Monti urinary diversion - a positive tumour margin led to resultant cystectomy and ileal conduit.