Department of Urology, University College London Hospital, Ground Floor North, 250 Euston Road, London NW1 2PG, UK.
Nat Rev Urol. 2015 Dec;12(12):671-80. doi: 10.1038/nrurol.2015.230. Epub 2015 Oct 13.
Female urethral diverticula are rare, benign epithelium-lined outpouchings of the female urethra. Patients can present with a multitude of symptoms, most commonly urinary incontinence, recurrent UTIs and dyspareunia. These presenting symptoms are often confused with other diagnoses leading to delayed diagnosis or misdiagnosis. Diagnosis and preoperative assessment of bladder function is most accurate using a combination of clinical examination, T2-weighted postvoid MRI and videocystometrography. Best treatment is by vaginal excision, a procedure with a very low recurrence rate and high patient acceptability. Excision also results in high cure rates for associated dyspareunia, UTI and voiding dysfunction. Pre-existing urodynamically proven stress urinary incontinence (USUI) resolves in 50% of patients after excision of the diverticulum with Martius labial fat pad interposition without the need for further treatment. Potential adverse effects after surgery are new-onset USUI, urethrovaginal fistula and urethral stricture. The rate of onset of these potential adverse effects is low and related to the preoperative appearance of the diverticulum on an MRI scan and the complexity of the diverticulum.
女性尿道憩室是一种罕见的、良性的女性尿道上皮衬里的外袋状结构。患者可能出现多种症状，最常见的是尿失禁、反复尿路感染和性交困难。这些表现症状常与其他诊断相混淆，导致诊断延迟或误诊。使用临床检查、T2 加权排空 MRI 和尿动力学检查相结合，对膀胱功能进行诊断和术前评估最为准确。最佳治疗方法是阴道切除，该手术复发率低，患者接受度高。切除还能有效治愈相关的性交困难、尿路感染和排尿功能障碍。对于术前已证实存在的压力性尿失禁（USUI），50%的患者在切除憩室后，采用 Martius 阴唇脂肪垫转移术可治愈，无需进一步治疗。手术后可能出现新的压力性尿失禁、尿道阴道瘘和尿道狭窄，这些潜在的不良反应发生率较低，与术前 MRI 扫描中憩室的外观以及憩室的复杂性有关。
