ACQUIRED MALE URETHRAL DIVERTICULUM FOLLOWING RADICAL PERINEAL PROSTATECTOMY
Murányi Mihály dr., Farkas Antal dr., Kiss Zoltán dr., Flaskó Tibor dr. Debreceni Egyetem Klinikai Központ, Urológiai Klinika, Debrecen (igazgató: Flaskó Tibor dr.)
Objective: Urethral diverticula of the male urethra are uncommon clinical entities which may be either acquired or congenital. Acquired diverticula can be caused by urethral trauma, infection, urethral stricture, prolonged urethral catheterization, substitution urethroplasty, hypospadias repair and artificial urinary sphincter placement. A patient with urethral diverticulum after radical perineal prostatectomy is reported. To our knowledge, our case is the second in a patient after radical prostatectomy.
Case presentation: The 76-year-old male patient had a past medical history of radical perineal prostatectomy in 2002. Postoperative cystography showed large extravasation; therefore the urethral catheter was left for 4 weeks. 9 months later the patient was admitted with perineal pain and swelling caused by perineal abscess and urethroperineal fistula. Drainage of the abscess was performed besides insertion of an indwelling urethral catheter and antibiotic treatment. Three weeks later the abscess was healed and cystography revealed no fistula or extravasation, but the fistula came back thus transurethral resection of the diverticular neck was performed. 2 weeks later the catheter was removed and the fistula was closed. Thereafter patient had no urinary symptoms except mild stress urinary incontinence. 13 years after the radical perineal prostatectomy, in 2015, patient was admitted with perineal pain and swelling again. Retrograde urethrography and urethroscopy revealed a 45×20 mm urethral diverticulum just proximal to the external urinary sphincter. Diverticulectomy and urethral reconstruction was performed by perineal approach. Postoperative period was uneventful. Urethral catheter was removed three weeks later. Follow up retrograde urethrography showed no extravasation. Histopathological examination revealed diverticulum lined by keratinized stratified squamous epithelium and granulation tissue. Repeated urinary and perineal symptoms were not observed during 18 months follow-up period, but his urinary incontinence became more intense.
Conclusion: Due to the rarity of male urethral diverticula, there is no consensus on the optimal management. Treatment of urethral diverticula is selected based on patient’s complaint, size of the diverticulum and extent of involvement of the urethra. Small asymptomatic urethral diverticula generally do not require surgery, while small symptomatic diverticula can be treated by transurethral resection. Patients with large, complicated diverticula are candidates for complete diverticulectomy, while if the urethral defect is large, diverticulectomy with urethroplasty might be necessary
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