以逐漸膨大的尿道腫瘤表現的大型尿道憩室
張雲筑1、林志杰1,2,3、林登龍1,2,3
台北榮民總醫院 泌尿部1；國立陽明大學醫學院 泌尿學科2書田泌尿科學研究中心3
A huge urethral diverticulum presenting as an
enlarging urethral mass
Yun-Chu Chang1, Chih-Chieh Lin 1,2,3, Alex T-L Lin1,2,3
Department of Urology, Taipei Veterans General Hospital1; School of Medicine2 and Shu-Tien Urological Institute3, National Yang-Ming University, Taiwan
Introduction:
The symptoms and signs of urethral diverticula are various. The incidence of urethral diverticula in adult females is estimated to be less than 20 per 1,000,000 (<0.02 percent) per year.
Case presentation:
This 35 year-old female has past medical history of G1P0(NSD).Two years ago, she accidently found a mass around 2cm in size located in anterior vagina while taking shower. There was no swelling or painful sensation. Cloudy discharge on milking was also noted. There was no dysuria or difficult voiding. She thought it was local infection that she didn’t pay much attention at first. However, the mass became bigger in size with time. She thus came to our GU OPD for further evaluation. Physical examination found a 4cm soft mass located in anterior vagina without erythematous change, tenderness or opening. Video-urodynamic study found a urethral diverticulum during voiding cystourethrogram, initially presented around right aspect of mid-urethra. Residual urine was 3 ml after voiding. Uroflowmetry found voided volumn 279ml, with maximal rate 31.6ml/sec and mean rate 16.4ml/sec. The magnetic resonance imaging found a large periurethral cystic lesion about 4.5x3.9x3.7 cm in size, with internal septa and sedimentation, rule in urethral diverticulum. The urinalysis found RBC 3-5/HPF and WBC/PUS 1+/HPF. She received transvaginal diverticulectomy in our department under general anesthesia. First we performed urethroscopy to identify the suspicious opening of the diverticulum. A 3 fr urethral catheter was inserted into the opening as a guidance. Via an anterior vaginal wall inverted U incision, the diverticulum was dissected carefully from peri-urethral tissue. The three-layer closure was done for the repair of periurethral fascia. The post-op course was smooth. Video-urodynamic study performed on the post operative 1 months found no redisual urethral diverticulum. Thus the Foley catheter was removed. There was no residual urine after voiding and the uroflow was good. The urinalysis showed normal finding.
Conclusion:
The classic presentation “3 D’s” in urethral diverticulum are described as post-voiding dribbling(4–31%), dysuria (9–55%), and dyspareunia(6-24%). We presented a case of urethral diverticulum whose clinical picture was not typical.