urethral diverticulum
Introduction
Introduction to urethral diverticulum The urethraldiverticulum refers to a cystic cavity that communicates with the urethra around the urethra. It can be congenital or acquired. Congenital urethral diverticulum is more common in women, mostly single, located between the urethra and the vagina; in men, it is located in the ventral side of the urethra at the junction of the penis and scrotum. The size of the diverticulum and the width of the neck are different, and the degree and symptoms of urinary tract obstruction are also different. basic knowledge Sickness ratio: 1.4%-5% Susceptible people: no special people Mode of infection: non-infectious Complications: urinary tract obstruction urinary fistula urethra stones
Cause
Urethral diverticulum
Congenital urethral dysplasia (30%):
Also known as primary urethral diverticulum or true diverticulum, the real cause is still unclear, may be caused by the following four reasons: (1) congenital dysplasia of the corpus cavernosum: weak ventral tissue of the urethra, pressure of the urinary flow dilates the anterior wall , protrusions, forming a diverticulum. (2) urethral groove is not fused: like the hypospadias, the urethral wall is partially deficient, but the surrounding tissue is well developed, forming a diverticulum. (3) The cell cluster remaining in the urethra at the time of embryo: it develops into a saclike shape, and then communicates with the urethral groove, which becomes a diverticulum. (4) The distal end of the diverticulum often has urethral stricture: therefore the effect of the distal urethral stricture of Campbell's diverticulum on the formation of the diverticulum. If the distal stenosis has a repeating urethra and the tip is a blind tube, the paraurethra gradually expands to form a diverticulum.
Abscess around the urethra (20%):
The abscess around the urethra penetrates the urethra and forms a diverticulum. The pathogen is a mixed infection of Gram-negative bacilli, and Egypt has been reported to be caused by schistosomiasis. The diverticulum is located in the prostate, mostly caused by prostate abscess, clinically more common.
Urethral trauma (25%):
This is the most common cause. After urethral injury, peripheral hematoma, extravasation of urine, infection failed to fully drain in time, and the surrounding tissue was mechanized to become the wall of the diverticulum.
Urethral stones (10%):
The stones stay in the urethra, compressing the urethra, local necrosis, and piercing, forming a diverticulum.
Pathogenesis
Congenital urethral diverticulum, with epithelial cells in the wall, smooth muscle fibers in the wall of the diverticulum, machined fibrous tissue in the posterior diverticulum, and congenital urethral diverticulum in the penis and bulbar urethra, located in the ventral side of the urethra, acquired Any part of the urethra can occur (Figure 1), the size of the diverticulum is different, the congenital diverticulum is wide, the acquired mouth is generally small, at the distal end of the diverticulum, some have valves, some think The valve is caused by poor urethral connection, but it may also be that urine enters the diverticulum during urination. The pressure in the sputum presses the anterior lip of the diverticulum into the urethra, forming a valve that affects drainage of the diverticulum. The sputum can be infected, stones, and worn. After urinary fistula is formed.
Prevention
Urethral diverticulosis prevention
The disease belongs to the congenital urethral diverticulum, also known as the primary urethral diverticulum or the true diverticulum. The real cause is still unclear. Therefore, there is no effective preventive measure, the focus is on early detection, early diagnosis and early treatment are important for the prevention of this disease. Pay attention to strengthening nutrition during pregnancy, and eat more fruits and vegetables to supplement enough vitamins, which is conducive to the development of the fetus in the right direction.
Complication
Urethral diverticulum complications Complications, urinary tract obstruction, urinary fistula, urethra stones
Open large diverticulum generally only causes urinary tract obstruction. Due to poor drainage, the narrow neck diverticulum can be complicated by infection and stones. If the diverticulum is secondary to infection, there is local pain, redness and tenderness, and there is purulent urine discharge in the diverticulum. After being worn through the skin, urinary fistula can be formed, and when the stone is formed, the diverticulum is hard and has a sandstone sensation.
Symptom
Urethral diverticulum symptoms Common symptoms Male urinating tingling urinary tract urethral cord urinary sinus
The small diverticulum has no clinical symptoms and is not easy to be found. The diverticulum is large. When the urine is infused into the chamber during urination, the mass can be seen or touched on the ventral side of the urethra. The mass can be compressed. When compressed, there can be urine from the urethra. Drip out.
Those with the above clinical symptoms should be suspected of the disease. If the mouth of the diverticulum is large, the catheter can be inserted into the diverticulum during catheterization. Sometimes the catheter can be curved in the large urethral fistula, and the curved catheter can be touched by hand.
Examine
Urethral diverticulum examination
When the diverticulum is infected, the urine routine examination may have red blood cells, white blood cells, and urine culture may have pathogenic bacteria.
Urethral angiography can be seen in the diverticulum, the posterior urethral diverticulum should be urinary bladder urethra angiography, urethroscopic examination, also helpful in diagnosis, but should be careful to avoid wearing the diverticulum.
Other tests such as CT and MRI after urethra and cystography can be confirmed.
Diagnosis
Diagnosis and differentiation of urethral diverticulum
diagnosis
If there is clinical symptoms, the disease should be suspected. If the mouth of the sputum is large, the catheter can be inserted into the sputum during catheterization. Sometimes the urinary catheter can be bent in the large urethral fistula, and the curved catheter can be touched by hand.
Differential diagnosis
1. Urinary calculi: There is no sacral urethra in the urination, and the metal probe can touch the stone. X-ray or B-ultrasound can also be confirmed.
2. Urethral tumors: may have hematuria and difficulty urinating. There is a filling defect in urethrography, and the urethroscopic microscope can directly observe the tumor and take a biopsy.
3. Bladder stones: The main thing is to determine whether it is the original stone or the stone formed by the foreign body.
