A Urethral diverticulum usually does not have a clear cause, but it is linked to various potential conditions, which include:

1. Weakening of the urethral wall as a result of repeated or multiple infections.
2. Obstruction to the urethral glands.
3. It can be a birth defect.
4. Due to a trauma during childbirth.

Symptoms of the Urethral diverticulum are not directly proportional to the size of the sac formed. Symptoms might be different for everyone. Studies say that 20% of patients don’t experience any clear signs. However, the most common symptoms include:

1. A frequent need to urinate
2. Pain during urination
3. Discomfort in the pelvic area due to the mass
4. Frequent urinary tract/urinary bladder infections
5. Presence of blood in the urine
6. Difficulty in emptying the bladder
7. Urine leakage or incontinence
8. Pain while having sexual intercourse
9. Post-void dribbling
10. A vaginal discharge
11. Nocturia or the urge to urinate multiple times at night
12. Urinary blockage
13. Tenderness in the vaginal wall

Usually, the urethral diverticulum has no clear signs, and hence diagnosing the same can get trickier at times for doctors. Patients have been misdiagnosed at times and treated for other conditions. However, with modern techniques, diagnosing a urethral diverticulum has become common. Diagnosis is done by a physical exam or via imaging tests.

1. Physical exam: In a physical exam, the medical practitioner will feel the vaginal wall of the patient to check the presence of any masses and to identify an area of soreness, if any. If the doctor does feel any pocket or sac formed, they first try to gently squeeze the sac to remove urine or pus. The doctor also checks the patient’s medical history and asks for any symptoms. Various imaging tests are then carried out to confirm the diagnosis.
2. Urodynamic studies to measure the lower urinary tract infections or check for urinary incontinence.
3. Cystoscopy: This test is done to check the inside of the bladder or urethra for the presence and location of the opening of the sac or pouch formed.
4. Magnetic Resonance Imaging (MRI): This is a test that produces clear pictures of a body part using X-rays, and hence, the MRI test will be done around the urethra to check for the presence of any pocket or sac.
5. Ultrasound: High-frequency waves are passed through the body tissue, which converts into a photographic image of that tissue’s internal structure. This can be used to find any pocket or sac around the urethra.
6. Voiding cystourethrography and double-balloon positive pressure urethrography are other diagnostic tests used these days.

Surgery is the only way to treat and cure a Urethral diverticulum. If left untreated, there is very little information as to what happens further. Patients who don’t wish to undergo surgery, should take regular counseling and monitoring sessions from the doctors to ensure that things don’t worsen over time. However, surgery is the treatment of choice to get rid of the unwanted sac or pocket.

There are 3 surgical options:

1. Completely removing the sac: This is the most common option and is also known as diverticulectomy.
2. Opening the sac permanently into the vagina.
3. Transurethral incision of the diverticular neck.

During surgery, certain aspects need to be taken care of. For instance, the diverticular neck should be closed. The lining of the sac should be fully removed so that it does not come back again. A multi-layered closure should be performed.

The patients who chose the non-surgical option need to see their doctor for a proper follow-up process. For the patients who opted for surgeries, the recovery from the surgery takes about 2 to 3 weeks. A catheter will be placed, which helps in urination. The patient will have to be on antibiotics for 24 hours. If there are bladder spasms, those will be managed with the use of medications.

After 2-3 weeks of surgery, a voiding cystourethrogram is conducted. If there is no leakage, the catheter is removed. If there is leakage, a similar test is done again till the leakage stops.

Some side effects or complications that the patient might have post-surgery include:

1. Repeating urinary tract infections
2. Continuance of the previous symptoms
3. The sac or pocket would come back if it wasn’t completely removed
4. Urinary incontinence
5. Creation of a urethrovaginal fistula, which is a path created between the urethra and vagina

These are the risks associated with Kidney cancer surgery:

• Reaction with anaesthesia
• Too much bleeding
• Infection
• Incisional hernia
• Leakage of urine into the stomach
• Kidney failure
• Leakage of air in the chest cavity (pneumothorax)