|Year : 2006 | Volume
| Issue : 2 | Page : 152-153
Congenital dorsal urethral diverticulum: A rare case report
Samir Gupta, NP Dhende, SB Mane, JM Kirtane
Department of Pediatric Surgery, Grant Medical College, Mumbai, Maharashtra, India
N P Dhende
Department of Pediatrics Surgery, Ward 41, 1st Floor, J. J. Hospital, Byculla, Mumbai - 400 008
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Urethral diverticulum in males can be congenital or acquired (secondry to stricture, stenosis). Congenital urethral diverticulae of male urethra are rare. Most of them occur ventral to the native urethra, arising from the cystic dilatation of the Cowper's gland ducts. Ours is the report of urethral diverticulum, which was present on the dorsal side of the urethra, with splaying of the two corpora cavernosa and thinning of the corpus spongiosum. The diverticulum was excised and urethroplasty was done. Postoperatively there was a marked improvement in the symptoms, with good cosmesis
Keywords: Dorsal urethral diverticulum, giant diverticulum
|How to cite this article:|
Gupta S, Dhende N P, Mane S B, Kirtane J M. Congenital dorsal urethral diverticulum: A rare case report. Indian J Urol 2006;22:152-3
| Case Report|| |
A 9-year-old boy presented with complaints of post void dribbling, dysuria and repeated urinary infections. Investigations revealed an absent kidney on the left side, with right side pelvic kidney with duplex system and associated vesicoureteric reflux. Incidentally, in the micturating cystourethrogram [Figure - 1], a dorsal outpouching of the urethra was picked up in the region of the penile shaft. On clinical examination, his penile shaft had a dorsal tilt and a defect was palpable in between the two corpora.
In the first surgery, a common sheath reimplantation was done to correct the vesicoureteric reflux. There was no further episode of urinary tract infection, but his post void dribbling was persistent. Thus two months later, he underwent excision of the diverticulum, with urethroplasty. Corpora cavernosa on both sides were rotated medially to bridge the gap in between. This medial rotation also corrected the dorsal curvature of the penile shaft i.e., orthoplasty was achieved. Post void dribbling stopped postoperatively and the child had an adequate dry interval with good stream. Histopathology of the excised diverticulum revealed the presence of thinned out spongiosal tissue.
| Discussion|| |
This is an interesting and rare case report of a congenital dorsal urethral diverticulum, in a male child. The term urethral diverticulm is used to denote an epithelised, saccular dilatation that is separate from the urethra, but communicates by means of a discrete orifice. On the other hand, in cases of megalourethra, the whole of the anterior urethra is dilated secondry to the deficiency of the spongy and erectile tissue of the penis.
Maizel's et al described the more common ventral diverticulum, which arises from the main ducts of Cowper's bulbourethral glands and named them as Cowper's Syringocele. Bever et al further classified these syringoceles into open and closed varieties. Sommers et al described a dorsal urethral diverticulum of fossa navicularis (lacuna magna), which remains restricted to the glans and coronal region and its size is small, with associated anterior valve ( valve of guerin). Abeshouse classified the urethral diverticulam on etiological grounds i.e congenital or aquired In all these types however, the diverticulum most of the time, is on the ventral aspect of the bulbar urethra and can be observed during micturition as an outpouching.
Rovner et al presented a wider spectrum of megalourethra (giant diverticulum), which were further classified by Dorairajan into two varieties, scaphoid and fusiform; The prerequisite to label a large diverticulum as megalourethra is the deficiency of the corpus spongiosum (scaphoid type), while in the fusiform variety, both corpus spongiosum as well as corpora cavernosa are deficient, which gives it the typical bulged penis appearance. Megalourethra is associated with other congenital anomalies and therefore prognosis is poor in these cases.
Dorsal urethral diverticulum as seen in our case, was rare and unusual. It could not be fitted in the megalourethra (fusiform) variety or in lacuna magna. In our case, the diverticulum was in the penile shaft [Figure - 2], with wide mouth separating the two corpora cavernosa laterally. Corpus spongiosum was present, but thinned out as confirmed by histopathology, so it could not be considered as one of the megalourethra varieties. Anatomically, the diverticulum was occupying the dorsal two- third of the penile urethra,and therefore our case fitted well in one of the rare varieties of circumferential urethral diverticulum.Such diverticulums are seen more in females. However, a few cases have been reported in males as well. Excision of the diverticulum with urethroplasty is the standard treatment in these cases. This could not have been an acquired diverticulum also, as there was no obstruction to the urine flow seen in the segment of urethra distal to the diverticulum.
| References|| |
|1.||Maizels M, Stephens FD, King LR. Cowper's syringocele: A classification of dilatation of Cowper's gland duct based upon cliniucal characteristrics of 8 boys. J Urol 1983;129:111-4. |
|2.||Bevers RF, Abberberk EM, Boon TA. Cowper's syringocele: Symptoms, classification and treatment of an unappreciated problem. J Urol 2000;163:782-4. |
|3.||Sommer JT, Stephens FD. Dorsal diverticulum of fossa navicularis. J urol 1980;124:94-7. |
|4.||Seskin FE, Glassberg KI. Lacuna magna. J Urol 1994;152:980-2. |
|5.||Abeshouse BS. Diverticula of the anterior urethra in the male; A report of four cases and a review of the literature. U Rol Cut Rev 1951;55;690-707. |
|6.||Rovner ES, Wein AJ. Diagnosis and reconstruction of the dorsal or circumferrentially urethral diverticulum. J Urol 2003;170:82-6. |
[Figure - 1], [Figure - 2]