Divertículos da uretra feminina: uma revisão contemporânea

Introduction

Urethral diverticula affect from 0.6 to 4.7% of women, are a frequent cause of persistent urinary symptoms and can present with complications such as lithiasis and malignization. Today, underdiagnosis and diagnostic and therapeutic delay of female urethral diverticula are still common. The aim of this article is to analyse the state of art regarding ethiology, diagnosis and therapeutics of this disease.

Materials and methods

Bibliographic revision of articles published until January/2014 after search of the database Medline for the keywords: “female urethral diverticula”, “female urethral diverticulum”, “urethral diverticula”, “urethral diverticulum” and “female urethra”; and of bibliographic references of the articles obtained.

Results

Most female urethral diverticula are secondary to infection of the periurethral and urethral glands. Despite the classically described triad of dysuria, dyspareunia and post‐void dribbling, the clinical manifestations are diverse and unspecific. Over a third are palpable on gynaecologic examination. Imaging exams, namely magnetic resonance and ultrasound, have high diagnostic capability and contribute to surgical planning. Depending on location, conformation and associated symptoms, urethral diverticula can be managed conservatively or, more frequently, surgically.

Discussion

Clinical evaluation is still essential for the diagnosis of female urethral diverticula. Currently, magnetic resonance is considered to be the best modality to diagnose the diverticula and to exclude pre‐ and post‐operative complications. Less invasive techniques have been described but transvaginal urethral diverticulectomy yields the highest symptomatic cure rates.

Conclusion

Awareness of the medical community is the most powerful weapon to reduce the underdiagnosis and diagnostic delay associated with female urethral diverticula.