Editing Female Urethral Diverticulae (section)

== Diagnosis and Evaluation ==

=== UrologySchool.com Summary ===
*'''<span style="color:#ff0000">History and Physical Exam'''
*'''<span style="color:#ff0000">Labs'''
**'''<span style="color:#ff0000">U/A +/- culture'''
*'''<span style="color:#ff0000">Imaging'''
**'''<span style="color:#ff0000">Options (5)'''
**#'''Double-balloon positive pressure urethrography'''
**#'''VCUG'''
**#'''Intravenous urography'''
**#'''US'''
**#'''MRI'''
*'''<span style="color:#ff0000">Other'''
**'''<span style="color:#ff0000">Cystourethroscopy'''
**'''+/- UDS'''

=== History and Physical Exam ===

==== History ====
* '''<span style="color:#ff0000">Signs and Symptoms'''
**'''Notable for a range of clinical presentations ranging from completely asymptomatic (up to 20% of patients), incidentally noted lesions on physical examination or imaging, to very debilitating, painful vaginal masses associated with incontinence, stones, severe dyspareunia, and/or tumors'''
** '''<span style="color:#ff0000">Most common symptoms (3):'''
**#'''<span style="color:#ff0000">Storage LUTS'''
**#'''<span style="color:#ff0000">Pain'''
**#'''<span style="color:#ff0000">Infection'''
**#*'''<span style="color:#ff0000">Multiple bouts of recurrent cystitis should alert the possibility of a urethral diverticulum'''
**#** Reinfection, inflammation, and recurrent obstruction of the neck of the cavity are theorized to result in patient symptoms and enlargement of the diverticulum. This expansion occurs most commonly ventrally, resulting in the classic anterior vaginal wall mass palpated on physical examination in some patients with UD. However, it is important to note that these may also expand laterally, or even dorsally, about the urethra. Eventually, the abscess cavity ruptures into the urethral lumen, resulting in the communication between the UD and the urethral lumen.
** '''<span style="color:#ff0000">Other symptoms (8):'''
**#'''<span style="color:#ff0000">Dysuria'''
**#'''<span style="color:#ff0000">Hematuria'''
**#'''<span style="color:#ff0000">Post-void dribbling'''
**#'''<span style="color:#ff0000">Urinary retention'''
**#'''<span style="color:#ff0000">Incontinence (stress or urge)'''
**#'''<span style="color:#ff0000">Dyspareunia'''
**#'''<span style="color:#ff0000">Vaginal mass'''
**#*'''Patients may present with complaints of a tender or nontender anterior vaginal wall mass, which upon gentle compression may reveal retained urine or purulent discharge per the urethral meatus.'''
**#'''<span style="color:#ff0000">Vaginal discharge'''
**Vaginal pruritis is not a symptom associated with urethral diverticulum
** '''Size of the UD does not correlate with symptoms'''

==== Physical Exam ====
* '''<span style="color:#ff0000">Genitals'''
**'''<span style="color:#ff0000">Urethra may be gently “stripped” or “milked” distally in an attempt to express purulent material or urine from within the urethral diverticulum'''

=== Laboratory ===
* '''<span style="color:#ff0000">Urinalysis +/- culture'''
[[File:TAJU A 1589748 F0005 OC.jpg|alt=Cystoscopy with visualisation of urethral diverticulum ostium.|thumb|Cystoscopy with visualization of urethral diverticulum ostium at the 4 o’clock position just proximal to the mid-urethral sphincter. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6583718/ Source]]]

=== Imaging ===
* '''No single study can be considered the gold standard'''
*'''<span style="color:#ff0000">Options (5)'''
*#'''<span style="color:#ff0000">Double-balloon positive pressure urethrography'''
*#'''<span style="color:#ff0000">VCUG'''
*#'''<span style="color:#ff0000">Intravenous urography'''
*#'''<span style="color:#ff0000">US'''
*#'''<span style="color:#ff0000">MRI'''
* '''Imaging cannot reliably diagnose malignancy in a urethral diverticulum'''
=== Other ===
* '''<span style="color:#ff0000">Cystourethroscopy'''
**Patients with UD are often highly symptomatic, and endoscopic examination can be very difficult to initiate or complete without anesthesia.
** The UD ostium can be very difficult to identify in some patients
** Stones within the urethral diverticulum may be diagnosed 4-10% of the time