Diverticulum of the Urethra after Urethroplasty: About A Case Report

Graiouid M, Bai W, Dakir M, Debbagh A and Aboutaib R

Published on: 2019-09-18

Abstract

We report the observation of a urethral diverticulum in a 14-year-old child after urethroplasty following a circumcision accident. We will describe the diagnostic and therapeutic aspects through the observation and a review of the literature.

Keywords

Diverticulum of the Urethra; Circumcision Accident; Urethroplasty

Introduction

The diverticulum of the male urethra is rare clinical entities. The diverticulum posturetroplasty is a rather rare complication, little described in the literature. It can be congenital or acquired. The acquired form is the most common, representing 90% of the diverticula of the urethra in men, most often complicating an urethroplasty. The treatment will require an open surgery that will consist of performing a reduction plasty.

Observation

A 14-year-old boy, operated at the age of 3 for the subtotal section of the penis following a circumcision accident, he benefited from uretro-metatoplasty with simple post-op immediate follow-up. The patient was lost from view and then consults after eleven years for dysuria associated with urinary incontinence. The urogenital examination shows a 5 cm penis, a reduced apical meatus of caliber without palpable swelling (Figure 1).  Urinary urethrocystography after difficult catheterization of the urethral meatus shows a retromeatus addition image related to a diverticulum and the rest of the urethra is dilated (Figure 2). Ultrasound of the penis is normal. The patient was operated on and a diverticular flattening and excision of the excess material was made. Three months later a urethral plasty was performed associated with a meatotomy. The evolution was good and no fistula or recurrence was observed after 3 months.

Discussion

The diverticulum of the male urethra is a rare entity, and no case of diverticulum of the urethra in children after surgical repair of circumcision accident has been reported in the literature [1]. It can be congenital or acquired. Acquired variety is the most common diverticula of the urethra in men most often secondary to urethroplasty [2]. The clinical symptomatology is polymorphic and depends on the existence or not of complications. The most constant sign is urinary flow post micturition with the presence of latent drops. They can be revealed by repeated urinary tract infections, hematuria, swelling of the penis [3-4]. The diverticulum may become bulky or complicate with stones and manifest as dysuria or even acute retention of urine [5]. The diagnosis of the diverticulum is confirmed by retrograde and void urethrocystography which appears as an addition image, of oval shape, most often at the expense of the ventral side of the urethra. Downstream stenosis may be found at the distal anastomosis of the urethra. Ultrasound can supplement the radiological assessment by visualizing the diverticulum and the walls of the urethra. Treatment will require open surgery. It involves excising the diverticulum and restoring continuity in a time. In the case of inflammatory perurethral tissue or a stenosis downstream, flattening with a second-stage plasty 3 months later is preferable [6-7].

Conclusion

The diverticulum of the male urethra after urethroplasty is a rare condition. It should be suspected in lower urinary tract disorders associated with periurethral mass. Urethrocystography is sufficient to confirm the diagnosis. Total diverticulectomy is the gold standard because it can restore normal urethral anatomy and avoid complications.

References

Figures

Figure 1: appearance of the penis on clinical examination.

Figure 2: UCR objectifying the image of retromatic addition.