This tab groups the less common urethral problems: post-prostatectomy vesicourethral distraction defects, urethral hemangioma, male urethral diverticulum, and urethrocutaneous fistula.
Vesicourethral Distraction Defects
A complication of radical prostatectomy in which the bladder neck and urethra are distracted apart. Determining the defect length accurately is essential. Options include an indwelling suprapubic tube, endoscopic treatment, a continent catheterisable bladder augmentation (often a better choice than aggressive functional reconstruction), or diversion.
Urethral Hemangioma
A rare, usually persistent lesion — all reported cases have been benign. Management depends on symptoms, size, and location: asymptomatic lesions are observed (they can regress spontaneously), while symptomatic lesions must be completely excised to prevent recurrence (laser for small lesions, open excision for larger ones).
Male Urethral Diverticulum
- Congenital — from incomplete urethral development; a prostatic urethral diverticulum may be a large remnant of the müllerian duct, associated with defects of diminished virilisation.
- Acquired — from urethral injury causing an intraspongiosal hematoma.
On evaluation, a catheter tip tends to catch in the diverticular opening, so the tip must be directed toward the true lumen. Most diverticula need no treatment unless very large; large ones accumulate urine and cause recurrent UTI or post-void "incontinence." Endoscopic unroofing relieves voiding symptoms (with subsequent post-void dribbling), and open repair excises the redundant urethra.
Urethrocutaneous Fistula
A complication of urethral surgery, periurethral infection (inflammatory strictures or treatment of a urethral growth), or urethral carcinoma — be cautious in a patient with a fistula or periurethral abscess without chronic obstructive symptoms, as this may be the hallmark of urethral carcinoma. Management is directed at both the defect and its underlying cause: complex posterior fistulae often need omental interposition, and radiation greatly magnifies the difficulty (tissue interposition is the rule, and diversion may be safest).
Self-Test
1. What usually causes a prostatic urethral diverticulum? A large remnant of the müllerian duct, associated with defects of diminished virilisation.