Urethral Diverticulum with Endometriosis

Dong Sup Lee, Sung Hak Kang, Chang Hee Han, Eun Jung Lee, Moo Yeul Chung, Yong Seok Lee
In: Korean Journal of Urology · 2008 · vol. 49(7) , pp. 664 · doi:10.4111/kju.2008.49.7.664 · W1972887098
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This paper reports a case of a 58-year-old woman diagnosed with urethral diverticulum secondary to endometriosis, treated with surgical repair.

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This case report describes the successful surgical treatment of a 58-year-old woman presenting with a protruding vaginal mass, which was diagnosed as a urethral diverticulum caused by endometriosis. Preoperative imaging identified a multiseptated cystic lesion, and histological examination confirmed the presence of ectopic endometrial glands and stroma within the dense fibromuscular tissue. The authors note that while acquired urethral diverticula resulting from endometriosis have been reported elsewhere, this represents the first such documented case in Korea. This paper is centrally about endometriosis — specifically its rare presentation as an acquired urethral diverticulum requiring surgical excision.

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Abstract

The differential diagnosis for women presenting with chronic genitou-rinary symptoms is extensive. Urethral diverticulum has long been thought to be responsible for these symptoms in some women. Although the etiology of urethral diverticulum in women is unclear, a number of different theories have been advanced for the formation of diverticula including either a congenital or acquired etiology. A few cases of acquired urethral diverticulum have been reported that resulted from endome-triosis; however, there have been no such cases reported in Korea. We recently treated a 58-year-old woman who presented with complaints of a protruding mass through the vaginal wall. A diagnosis of urethral diverticulum secondary to endometriosis was finally made. The patient underwent surgical repair. Here we report this case and review the medical literature.
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Abstract

The differential diagnosis for women presenting with chronic genitourinary symptoms is extensive. Urethral diverticulum has long been thought to be responsible for these symptoms in some women. Although the etiology of urethral diverticulum in women is unclear, a number of different theories have been advanced for the formation of diverticula including either a congenital or acquired etiology. A few cases of acquired urethral diverticulum have been reported that resulted from endometriosis; however, there have been no such cases reported in Korea. We recently treated a 58-year-old woman who presented with complaints of a protruding mass through the vaginal wall. A diagnosis of urethral diverticulum secondary to endometriosis was finally made. The patient underwent surgical repair. Here we report this case and review the medical literature. Fig. 1 Preoperative computed tomography revealed about a 5.5×5.3×5cm round multiseptated cystic like mass (A: transverse view, B: coronal view, C: sagittal view). Fig. 2 The microscopic view shows ectopic endometrial glands and stroma in the dense fibromuscular tissue (A: H&E, reduced from ×40, B: reduced from ×400). Fig. 3 Postoperative computed tomography showed that the fluid containing cystic mass regressed (A: transverse view, B: coronal view).

References

- Hey W. In: Practical observations in surgery. Philadelphia: James Humphreys publishers; 1805. pp. 303. - - Silk MR, Lebowitz JM. Anterior urethral diverticulum. J Urol 1969;101:66–67. - - Johnson CM. Diverticula and cyst of the female urethra. J Urol 1938;39:506–516. - - Huffman JW. The detailed anatomy of the paraurethral ducts in the adult human female. Am J Obstet Gynecol 1948;55:86. - - Chowdhry AA, Miller FH, Hammer RA. Endometriosis presenting as a urethral diverticulum: a case report. J Reprod Med 2004;49:321–323. - - Davis BL, Robinson DG. Diverticula of the female urethra: assay of 120 cases. J Urol 1970;104:850–853. - - Sanfilippo JS, Williams RS, Yussman MA, Cook CL, Bissonnette F. Substance P in peritoneal fluid. Am J Obstet Gynecol 1992;166:155–159. - - Wu YC, Liang CC, Soong YK. Suburethral endometrioma. A case report. J Reprod Med 2003;48:204–205. -

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endometriosis

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