|Year : 2001 | Volume
| Issue : 1 | Page : 86-88
Congenital diverticulum of male urethra
K Natarajan, P Sivaram, Joseph Thomas, K Sashidharan
Department of Urology, Kasturba Medical College, Manipal, Karnataka., India
Department of Urology, Kasturba Medical College, Manipal, Karnataka- 576119
Source of Support: None, Conflict of Interest: None
Keywords: Urethral Diverticulum; Male Urethra.
|How to cite this article:|
Natarajan K, Sivaram P, Thomas J, Sashidharan K. Congenital diverticulum of male urethra. Indian J Urol 2001;18:86-8
| Introduction|| |
Congenital urethral diverticula are rare in males. Urethral diverticulam generally located in the ventral aspect of the anterior urethra, though it can be found anywhere from the bulbous to the mid pendulous portion of the urethra. Herein we present 2 cases of congenital urethral diverticula in males.
| Case Report|| |
A 45-year-old gentleman presented with history of postvoid dribbling and an insidiously enlarging swelling at the penoscrotal junction since childhood. The swelling became more prominent during the act of voiding. He has not been evaluated for the above problem in the past. His general condition was unremarkable. Examination of the external genitalia disclosed at the penoscrotal junction a soft swelling measuring about 6 x 4 cms [Figure - 1]. Digital compression collapsed the swelling and yielded conspicuous turbid urinary discharge from the meatus. His urine analysis showed numerous white blood cells and urine culture grew E.coli .
Ultrasonography revealed bilateral normal upper tracts, good capacity bladder and normal sized prostrate of regular echo texture. An ascending contrast study of the urethra and subsequent cystourethroscopy readily disclosed a large wide mouthed diverticulum disposed at the penoscrotal junction. Excision of the diverticulum [Figure - 2] and urethral reconstruction was carried out uneventfully.
A 35-year-old gentleman presented with history of swelling under the penis since young. Patient developed high grade temperature and severe pain over the swelling 2 months back. The lesion was incised and drained elsewhere on the premise of a periurethral abscess following which a stone measuring 4 x 3 cms was spontaneously ejected from the incised site. The patient reached our center with suprapubic cystostomy in position.
On evaluation ultrasonography revealed bilaterally normal upper tracts with good capacity bladder. An ascending urethrogram [Figure - 3] and voiding cystourethrogram revealed a large diverticulum at penoscrotal junction. Cystourethroscopy showed a wide-mouthed diverticulum at penoscrotal junction. Excision of the diverticulum with urethroplasty was carried. Patient had an uneventful recovery.
| Discussion|| |
Diverticulum of the urethra is a saccular or tubular dilatation of the urethral wall that communicates with the lumen by means of a neck. Urethral diverticulum may be congenital or acquired. Congenital diverticulum is rare.
Various theories attempt to explain the formation of the congenital urethral diverticulum. The first hypothesis is that it is derived from the partial lack of spongy body, representing incomplete hypospadias. Second hypothesis links it with valves of the anterior urethra, appearing secondarily to these, which are, in turn a consequence of the absence of linkage between urethral segments. The third hypothesis is that congenital urethral diverticulum arises from the spontaneous rupture of the paraurethral cysts towards the lumen of the urethra. These cysts are secondary to the obstruction of the abnormal paraurethral glands or of ectopic epithelial cell nests.
Congenital urethral diverticula may be either saccular or tubular. The saccular type has a true neck and may cause urinary obstruction since its posterior segment compresses the urethra and interrupts the urinary flow when the saccular cavity fills at the beginning of micturition. The tubular or diffuse type is located more proximally to the urethral bulb, where urinary stasis occurs along with its complications, such as urinary stasis and calculosis.
The symptoms depend largely on the size of the diverticulum. The smaller ones often show no symptoms, becoming evident only when other problems such as urethritis occur. The larder diverticula tend to retain urine, harboring infection and leading to difficulties in micturition and dysuria. Diagnosis of a urethral diverticulum is often clinical. On clinical examination, the mass is palpated in the bulbar region; it disappears when compressed and is followed by outflow of urine or infected material through the urethra. Confirmation of the diagnosis is made through ascending urethrogram and micturating cystourethrogram. Urethral diverticulum management depends on the type and size of diverticulum. Small diverticulum usually can be managed by endoscoic approach whereas large diverticulum requires open surgical excision.
| References|| |
|1.||Nelson Rodrigues Netto, Gustavo Caserta Lemos. Joaquin Francisco De Almeida Claro. Flavio Luiz Ortiz Hering. Congenital diverticulum of male urethra. Urology/September/I984/Volume xxiv, Number 3. |
|2.||Dorairajan T: Defects of spongy tissue and congenital diverticula of the penile urethra. Aust NZ J sur,_ 32:209 (1963). |
|3.||Boissonnat P and Duhamel B. Congenital diverticulum of the anterior urethra associated with aplasia of the abdominal muscles in the male infant. Br J Urol 34:59 (1962). |
[Figure - 1], [Figure - 2], [Figure - 3]