Congenital anterior urethral diverticulum: sonographic diagnosis

Urinary incontinence secondary to a suspected congenital urethral deformity in a kitten

Case summary

A 5-month-old entire male domestic shorthair kitten was referred for investigation of a month-long history of urinary incontinence. Clinical examination, baseline blood work and imaging (plain radiography and ultrasonography) were unremarkable. Urinalysis documented a urinary tract infection and a retrograde urethrocystogram revealed an outpouching of the pelvic urethra. Surgical exploration revealed the absence of the dorsal portion of the urethral wall in this section of pelvic urethra, replaced by an epithelial lined expanded ‘pouch’. The ventral aspect of the urethra appeared grossly normal. A modified perineal urethrostomy was performed to create an anastomosis of the urethral pouch to the skin of the perineum alongside conventional castration. The kitten made a full recovery and the incontinence resolved within 48 h. A congenital urethral diverticulum and secondary urinary tract infection were deemed the most likely aetiology in this case.

Relevance and novel information

Urethral diverticuli are a rare condition in veterinary medicine. To our knowledge, it has only been reported in two dogs and presumptively in one cat, all of which made a complete recovery after surgical intervention. The present case reports an unusual urethral deformity as a potential differential diagnosis for lower urinary tract signs in a young cat.

Congenital anterior urethral diverticulum presenting as a scrotal mass in a two-year-old child

Here, we describe a case of congenital anterior urethral diverticulum (CAUD) in a two-year-old boy, who presented with right inguinoscrotal swelling that mimicked a spermatic cord cyst or hydrocele. Accurate diagnosis was made intraoperatively by retrograde urethrography. Open diverticulectomy and primary urethroplasty were performed for its management. The clinical presentation, diagnosis, and the management of this rare condition is discussed.

Congenital anterior urethral diverticulum

Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra and may present itself at any age, from infant to adult. Most children with this condition present with difficulty in initiating micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that these children never had a good urinary stream since birth, and the telltale sign is a cystic swelling of the penile urethra. In this paper, we present two cases of CAUD that were managed by excision of the diverticulum with primary repair.

Traumatic urethral diverticula: a rare malformation of the male urethra

Urethral diverticula are pouches opening into the urethral canal that may be either acquired or congenital. Diverticula of the female urethra are fairly common. However, diverticula of the male urethra are relatively uncommon abnormalities. Clinical manifestation is frequently described with irritative and/or obstructive voiding symptoms or ventral bulging, but manifestation as a scrotal mass is extremely rare. We report a giant urethral diverticulum presenting as a scrotal mass in an adult male.

Multiple urethral anomalies: anterior urethral diverticulum, posterior urethral valves, and distal hypospadias

We report an infant with antenatally detected bilateral hydroureteronephrosis and a penile cyst who was eventually diagnosed with an anterior urethral diverticulum (AUD), subcoronal hypospadias, and posterior urethral valves (PUV) after birth. To our knowledge, there are no reports where all three anomalies have been found to coexist. As per urethral catheterisation was difficult, cystoscopy-guided catheterisation was performed. On retracting the complete foreskin, a subcoronal hypospadias was identified. The AUD was resected partially, and during a cystoscopy for completion of AUD resection, a dilated anterior urethra was found collapsed, and thin PUV were identified and divided. He remains well at nine months with an improving renal cortical thickness. The vesicoureteric reflux had resolved.

Acquired urethral diverticulum in a man with paraplegia presenting with a scrotal mass: a case report

Introduction

Male urethral diverticula are rare. Patients with paraplegia may present with acquired diverticula as a result of prolonged catheterization. Diverticula may be asymptomatic or lead to lower urinary tract symptoms. Rarely, the diverticulum may initially present as a scrotal mass.

Case presentation

We report the case of a male 45-year-old Arab with paraplegia who presented with a mass in the peno-scrotal junction. He had in his medical history iterative prolonged urethral catheterizations associated with urine leakage through the urethral meatus upon applying compression. Diagnosis confirmation of urethral diverticula is obtained by retrograde urethrography. The patient underwent a diverticulectomy with urethroplasty.

Conclusion

Male acquired urethral diverticula can be found in patients who have a spinal cord injury because of prolonged urethral catheterization. Clinical presentations are different and sometimes can be misleading. Retrograde urethrography is the key to diagnosis and open surgery is the treatment of reference.

Congenital anterior urethral diverticulum in children: a case report and review

Congenital anterior urethral diverticulum (CAUD) is an uncommon condition in children. We describe 2 patients of CAUD who presented with ventral penile swelling; in one, the site of swelling was just proximal to corona which is quite rare. The diagnosis was made on USG and MCU. Both patients had normal renal function. Open diverticulectomy and primary repair was done in both patients.

Congenital anomalies of the male urethra

The spectrum of congenital anomalies of the male urethra is presented. The embryologic basis of each anomaly, when known, is discussed. Clinical and imaging features of each entity are presented.

Urethral complications of urinary catheterization presenting as primary scrotal masses: sonographic diagnosis

We report on 2 debilitated male patients who had penile urethral complications of transurethral catheter drainage. One patient had a urethral diverticulum, and the other had a Foley catheter misplaced through a urethral perforation. Both lesions mimicked primary intrascrotal masses on physical examination and were therefore evaluated by scrotal sonography. The correct diagnosis of each lesion required careful examination of the mass and its anatomic relationship to the adjacent urethra. Penile urethral complications of catheterization in debilitated patients must be included in the differential diagnosis of scrotal cystic masses. These cases also emphasize the necessity of a thorough sonographic examination that extends beyond the specific area of presumed clinical interest.