abnormal area of localized urethral mucosa due to recurrent periurethral gland infections along the anterior vaginal wall , which can develop into an abscess that can eventually breach the urethral mucosa.
| Definition | • Urethral mucosa herniated into surrounding tissue |
|---|---|
| Clinical features | • Dysuria |
| • Postvoid dribbling | |
| • Dyspareunia | |
| • Anterior vaginal wall mass | |
| Diagnostic testing | • Urinalysis |
| • Urine culture | |
| • MRI of the pelvis (confirmation) | |
| • Transvaginal ultrasound | |
| Treatment | • Surgical excision of the diverticulum. |
The recurrent infection and inflammation of the urethral tissue creates the abnormal outpouching that can collect and store urine, resulting in postvoid dribbling and recurrent lower urinary tract infections (eg, dysuria).
Infection of the diverticulum can also lead to pain, often presenting as dyspareunia or a tender anterior vaginal wall mass with an associated expressed purulent or bloody urethral discharge.
<aside> 💡 doesn’t cause incontinence→ described in the Q as “the patient has had increasingly frequent involuntary loss of urine and now wears a sanitary napkin to prevent urine from dribbling on her clothes after she voids”
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(Choice C) Symptomatic pelvic organ prolapse can cause pelvic pressure and an anterior vaginal bulge (eg, cystocele); this condition is common in multiparous women, particularly those who have had vaginal deliveries and fetal macrosomia, such as this patient. However, pelvic organ prolapse typically causes a nontender vaginal bulge and is not associated with purulent discharge.