Chang Yu-Lung, Lin Alex T L, Chen Kuang-Kuo
Division of Urology, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
Urol Int. 2008;80(1):41-5. doi: 10.1159/000111728. Epub 2008 Jan 18.
Symptoms or signs of female urethral diverticulum are usually not typical, thereby resulting in delayed or wrong diagnosis. This paper relates to our experience on the diversity of presenting symptoms and signs of female urethral diverticula.
We reviewed the medical records and conducted telephone interviews of 14 patients with the diagnosis of female urethral diverticulum in our institution.
The mean patient age at diagnosis was 47.5 years (range 22-65 years) and the mean duration between symptom presentation and diagnosis was 6.46 years (range 1 month to 30 years). Their presenting symptoms were so diverse that many were initially treated under the diagnosis other than urethral diverticulum. Most patients were treated as uncomplicated urinary tract infection for a long time. Stress urinary incontinence (SUI) was so dominant in 2 patients with big diverticula that they were falsely treated with anti-incontinence surgery. Total incontinence happened in 1 patient with genuine SUI and a big urethral diverticulum. One patient with a huge diverticulum, which had a fistula opening into the vagina, presented with day- and night-time incontinence. Some patients even did not have incontinence, but only had dysuria or a painful anterior vaginal wall nodule. Nevertheless, detailed analysis on symptoms and signs usually may suggest urethral diverticulum. We found that recurrent urinary tract infection, urinary incontinence, palpable suburethral mass, vaginal tenderness, and dysuria are the five major presenting symptoms and signs. The diagnostic rate of voiding cystourethrography during video-urodynamics, double-balloon urethrography and MRI were 10/10 (100%), 6/6 (100%) and 10/11 (90.9%) respectively.
The presenting symptoms and signs of female urethral diverticula are often diverse and easily overlooked. High suspicion of this disorder, detailed history-taking and physical examination are essential for detecting urethral diverticulum in females.
女性尿道憩室的症状或体征通常不典型，从而导致诊断延迟或错误。本文介绍了我们对女性尿道憩室表现出的症状和体征多样性的经验。
我们回顾了本院14例诊断为女性尿道憩室患者的病历并进行了电话随访。
确诊时患者的平均年龄为47.5岁（范围22 - 65岁），症状出现至确诊的平均时长为6.46年（范围1个月至30年）。她们的临床表现多种多样，许多患者最初接受的治疗并非针对尿道憩室。大多数患者长期被当作单纯性尿路感染治疗。2例患有较大憩室的患者中压力性尿失禁（SUI）非常突出，以至于接受了抗尿失禁手术的错误治疗。1例真正患有SUI且尿道憩室较大的患者出现了完全性尿失禁。1例巨大憩室患者伴有通向阴道的瘘口，出现了日夜失禁。有些患者甚至没有尿失禁，仅有排尿困难或阴道前壁疼痛性结节。然而，对症状和体征进行详细分析通常可提示尿道憩室。我们发现复发性尿路感染、尿失禁、尿道下可触及肿块、阴道压痛和排尿困难是主要的五个临床表现。排尿期膀胱尿道造影在影像尿动力学检查中的诊断率为10/10（100%），双球囊尿道造影为6/6（100%），MRI为10/11（90.9%）。
女性尿道憩室的临床表现往往多样且易被忽视。高度怀疑这种疾病、详细的病史采集和体格检查对于发现女性尿道憩室至关重要。
