Characterization of urethral diverticula in males
Kathleen Olson1, Rohan Vaidya1, Aqsa Khan1
1Mayo Clinic Arizona, Phoenix, Arizona, USA.
Insights
Male urethral diverticulum is rare, often presenting with incontinence and frequently iatrogenic. Surgical treatment via diverticulectomy has a significant complication rate, including persistent incontinence and urethrocutaneous fistula.
Area of Science:
- Urology
- Male Reproductive System Disorders
Background:
- Male urethral diverticulum is an uncommon condition with limited literature.
- Characterizing this rare entity is crucial for understanding its presentation and management.
Purpose of the Study:
- To characterize urethral diverticulum in male patients across three Mayo Clinic locations.
- To analyze patient demographics, etiology, symptoms, diagnostic methods, treatments, and outcomes.
Main Methods:
- Retrospective chart analysis of male patients with urethral diverticulum or diverticulectomy.
- Data collected from 2003-2018, including patient age, etiology, symptoms, location, treatment, pathology, and outcomes.
- International Classification of Diseases (ICD) and CPT codes were used for patient identification.
Main Results:
- 52 male patients diagnosed with urethral diverticula; 83% located in the anterior urethra.
- Most common etiology was iatrogenic (77%); incontinence was the most frequent symptom (37%).
- Diverticulectomy performed in 42%; 18% experienced persistent incontinence, and 26% had postoperative complications like urethrocutaneous fistula.
Conclusions:
- Male urethral diverticulum is a rare but significant condition, particularly in patients with prior lower urinary tract surgery.
- Management requires careful consideration due to potential for persistent symptoms and complications post-diverticulectomy.
Introduction:
Urethral diverticulum in a male is a rare entity and the literature is limited to case reports and small case series. The aim of our study is to characterize this disease in patients from three Mayo Clinic locations.
Materials And Methods:
Chart analysis was performed of patients across all three Mayo Clinic sites that had International Classification of Diseases (ICD) codes corresponding to urethral diverticulum or urethral diverticulectomy via CPT code. Data were available for patients that were seen from 6/1/2003 through 10/5/2018. Patients were classified by age, etiology, presenting symptomatology, location, treatment, pathology, and postoperative outcomes.
Results:
A total of 87 men met the initial search criteria with 52 having documented urethral diverticula. The most common presenting complaint in these men was incontinence (37%). The majority of diverticula (83%) were within the anterior urethra. The most common diagnostic modalities were retrograde urethrogram (46%) and cystoscopy (50%). Most diverticula were iatrogenic (77%). Of the men that were diagnosed, 42% went on to have diverticulectomy. Median follow up was 1.5 years. Eighteen percent of patients had persistent urinary symptoms following diverticulectomy with incontinence being the most common finding. Postoperative complications were experienced by 26% patients with the most prevalent complication being urethrocutaneous fistula. The patients who did not undergo diverticulectomy either had other surgical procedure to manage their coexisting conditions or were managed medically.
Conclusion:
Urethral diverticulum in males is a rare yet important entity that requires special consideration, especially in those who have had prior surgery within the lower urinary tract.
Related Concept Videos
01:16Urethra
The anatomy of the urethra differs between males and females. In females, the urethra is short, measuring about 3–4 cm in length, and opens anterior to the vaginal opening. In males, the urethra is longer and passes through the penis, serving dual purposes: expelling urine and ejaculating semen. The male...
01:19Anatomy of the Genitourinary System II: Bladder and Urethra
01:22Ureters
01:23Urinary Bladder
In males, the bladder is situated in front of the rectum, while in females, it is positioned anterior to the vagina and uterus. The bladder floor contains an inverted triangular area called the trigone, defined by the two ureteric...
01:26Urinary Tract Calculi II: Pathophysiology and Clinical Manifestations
01:20Disorders of the Male Reproductive System
Prostate disorders are another major concern. These conditions can impair urinary flow due to the prostate's location around the urethra....