What is a Urethral Diverticulum? (Or how babies and urine ideally come out of different holes)

I got into blogging to first and foremost put my bizarre collection of symptoms up on the internet with as many details as possible to help other people who might have a similar collection of symptoms. What I have gotten out of it so far is a way to process what is happening to me and because of me in this healthcare journey, which is both more useful and more scary than I originally anticipated. I say that because while my first few posts were medically minded, I delved quickly into all of the feelings – so quickly, in fact, that I never actually explained what it is I had surgery to fix.

What did I have? A urethral diverticulum – a small outcropping of my urethra that caught urine every time I went to the bathroom. How did I get it? Basically, a periurethral gland (fancy name for a gland near my urethra that typically secretes mucus to maintain the pH/ protect the urethra from the acidity of urine) at some point got blocked and became a cyst. Because the gland didn’t get the memo that it was blocked/ needed to chill the heck out, it went on about its glandular, mucus secreting life. But because it was blocked, there wasn’t enough space for all of its work product, so it exploded like a zit. But in the process of overfilling, the space around the gland/cyst/bane of my existence got stretched out, and so every time I urinated after it exploded open, it caught a little bit of urine, which is a great way to get infections. Bonus! This didn’t just happen one time – the body has a generally great habit of healing itself, but it typically heals from the outside in, which meant that the part that connected the outcropping to my urethra kept healing over, but since the gland was still active, it just kept stretching, and exploding, and catching more urine, and heeling and stretching, and exploding, which presumably would have gone on forever.

How do they diagnose it? Like most things, it was basically diagnosed with a thorough history and a physical exam. Something I didn’t really appreciate before physical therapy school is that one of the most important parts of medicine and figuring out what the patient needs is taking the history – the healthcare provider is asking you questions because the answers will ideally guide your treatment. This has several important implications. 1. it means that you should answer the questions fully and honestly, in person and on forms. and 2. it’s important to find a doctor’s office that asks a lot of questions, or gets a good history, even before ordering a bunch of labs and imaging. It’s also worth noting that treatment suggestions and hypothesizing about the source of the patient’s complaint isn’t just matching the symptoms to a diagnosis, it’s also taking into account what is most or least likely based on other parts of the history – age, environment, demographics, etc, which is why diagnosing yourself via webMD isn’t an effective method of practicing medicine. All of your symptoms may match a description for a disease, but if that disease is primarily found in countries without access to clean running water and you’ve never been to a place like that, it’s not a likely culprit.

Ultimately, after all the history taking, my diverticulum was diagnosed by an MRI with contrast. You can also have it diagnosed by Voiding Cystourethrogram (VCUG) where they insert a catheter, fill your bladder up from the bottom up, remove the catheter, and watch you urinate in real time, on an x-ray table, while they x-ray your urinary tract. The imaging becomes important because while the structural issue is within the urethra, it’s usually accessed through the vaginal wall, which is part of what makes them difficult to diagnose in the first place.

What’s the treatment? Urethral diverticula aren’t life threatening, but when they’re symptomatic they’re really annoying. Mine was causing me all sort of urinary symptoms including urgency and frequency, and was also painful during intercourse, generally just cramping my style. My understanding is that the treatment is always surgical, to repair the stretched out tissue, and remove the section that is catching liquid. They cut through the vaginal wall to access the urethra, and do the repair there, closing up the urethra and then the vaginal wall. Because of those two layers and their proximity to one another, a catheter is necessary to keep urine out of the open wounds while they’re healing, as well as to keep the urethra and vagina separate for their distinct and separate purposes.