Health and Safety - Beyond The Abstract Urethral Diverticulum After Endoscopic Urethrotomy

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Beyond The Abstract Urethral Diverticulum After Endoscopic Urethrotomy
Diverticula of the male penile urethra are rare. Recognized etiologies for acquired male diverticula include trauma, impacted stones, strictures and infection. Iatrogenic injury following endoscopic urethrotomy should also be considered. Symptoms of urethral diverticula depend on their size, location, and the degree to which they cause obstruction. Men can present with hematuria, urinary tract infection, lower urinary tract symptoms, incontinence or post-void dribbling. There may be a palpable mass from which residual urine can be expressed. Static urine in a diverticulum may predispose infection andor to calculus formation. Most diverticula are diagnosed with urethroscopy, although other studies such as retrograde urethrography may be necessary to determine the extent of involvement. In the case presented here, we were unable to completely visualize the diverticulum with urethroscopy because of the recurrent penile urethral stricture, therefore pelvic MRI was used to evaluate for evidence of carcinoma and better define the location and size of the diverticulum. Treatment of a male urethral diverticulum depends on the degree of symptoms and risk of associated carcinoma. Small, asymptomatic lesions may be followed whereas diverticulectomy is recommended for large, symptomatic diverticula.

In the case presented here, the urethral diverticulum developed after endoscopic incision (direct vision internal urethrotomy, DVIU) of a urethral stricture located in the penile urethra. This is a very important aspect of this case. DVIU is indicated for short bulbar urethral strictures with little or no associated spongiofibrosis. The success of DVIU relies on the presence of healthy, well vascularized spongiosum. The spongiosal tissue surrounding the bulbar urethra is much thicker than that in the penile urethra. DVIU is generally not indicated for urethral strictures in the penile urethra for this reason. The spongiosum surrounding the penile urethra is much too thin to allow for effective, and in case, safe and uncomplicated DVIU. Recognition of this potential complication following DVIU and those urethral strictures in the penile urethra that are not appropriate for endoscopic incision are important learning aspects from this patients case.

Beyond The Abstract Urethral Diverticulum After Endoscopic Urethrotomy