Urology Clinic RBH

The Urology clinic in RBH is the centre of excellence in Bahrain for the following treatments -

Laser surgery for prostate diseases.
Laser surgery for kidney stones.
Urodynamic study and incontinence treatment.
Laparoscopic urology.
Microscopic varicocele surgery.
Erectile dysfunction and Penile Prosthesis implantation.
Infertility Treatment.
Female urology and Sexual health.
No Needle No scalpel Vasectomy.
Cancer Screening and treatment.
Plastibell Circumcision
.

URETHRAL DIVERTICULUM / VAGINAL CYST/ VAGINAL SWELLING

I have a vaginal swelling. My friend had urethral diverticulum and I am worried whether it is the same problem. Can you explain me about urethral diverticulum?
The female urethra is a muscular tube of approximately 4 cm in length which drains urine out of the urinary bladder. The inner one-third is lined by epithelium same as urinary bladder and the outer two-thirds is lined by epithelium which is the same as vagina. There are lots of glands a located along the outer two third of the tube and drain into the urethra.



A urethral diverticulum is a pouch or sac from the urethra. The opening of the sac originates in a defect in the muscular coat of the urethra. It is usually seen as an anterior vaginal wall swelling. Identification and treatment of this condition is important as delayed in treatment can cause complications like, chronic infections, fistula and rarely cancer transformation. This is usually seen around 2 % of adult females in our region. It is usually seen between 30-60 years age group but occasionally can be seen in other age groups. The common reasons that one may get this are previous surgery, child birth, recurrent infection, by birth or some unknown reasons.

What are the common symptoms of this problem?
The most common presentations are painful sexual intercourse, chronic burning micturition, dribbling or discharge from urethra post urination, vaginal swelling or cyst, Chronic frequency or and urgency symptoms. There are other condition which can mimic urethral diverticulum which includes vaginal wall inclusion cysts, Gartner duct cysts, Skene gland cysts, urethral caruncles, urethral prolapse, anterior vaginal wall prolapse.
        
What are the Investigations to confirm the diagnosis?
Pelvic examination-Palpation of the anterior vaginal wall may reveal a soft spherical mass, which may or may not be tender. Compression of the mass may express urine or purulent material from the external meatus.
Radiological Imaging of the urethra is usually performed to confirm a urethral diverticulum. We usually start with a Trans Vaginal  Ultrasound Scan and if inconclusive we go for MRI, voiding cystourethrography (VCUG), double-balloon urethrography (DBU), CT or  Urethroscopy.
Vaginal Diverticulectomy -The patient is placed in a delivery position and complete vaginal excision of the urethral diverticulum is the preferred technique for surgical management.
Please see the attached steps of surgery.













Transurethral Surgical Management-We use this to open the diverticular sac transurethrally for decompression and drainage into the urethra in case of abscess and then we do a delayed vaginal diverticulectomy.