Rethinking Urethral Diverticulum: A Narrative Review of Clinical Outcomes and Cancer Associations.

Introduction and hypothesis: Urethral diverticulum (UD) is a rare condition characterized by a pouch-like protrusion of the urethral mucosa into surrounding tissues. This review is aimed at synthesizing data on factors influencing surgical outcomes, postoperative complications, and the association between UD and malignancy.

Methods: A comprehensive literature search was conducted for studies published between 2014 and 2024. Inclusion criteria encompassed studies reporting patient outcomes post-UD repair, postoperative complications, or cases of UD-associated malignancy. Data were extracted and analyzed qualitatively owing to the heterogeneity of available studies.

Results: Thirty-two studies met the inclusion criteria, totaling 1052 patients with a median age range of 35-62 years; 86% of the patients were female. Transvaginal surgical excision has demonstrated success rates of 83% to 97%. Recurrence rates varied, with primary diverticulectomy showing 2% to 22% and urethroplasty 17%. Larger diverticula (> 3 cm) were linked to increased intraoperative blood loss (mean 450 ml vs 200 ml, p < 0.001). Anatomical complexity, such as circumferential diverticula, was associated with higher postoperative urinary tract infection rates (15% vs 7%, p = 0.02) and reduced surgical success (83% vs 97%, p < 0.05). Postoperative stress urinary incontinence occurred in 4% to 21% of patients. Eighteen cases of UD-associated malignancy were identified, predominantly adenocarcinoma (44%), with a mean age at diagnosis of 51.6 years.

Conclusions: Surgical outcomes for UD are influenced by factors such as diverticulum size and anatomical complexity. Postoperative complications are significant considerations. Further research with standardized reporting is essential to enhance understanding and management of UD.