If you’re an adult female dealing with frequent urinary tract infections (UTIs), urinary leakage, or pelvic pressure that won’t go away, it may be more than a routine infection. You might have a urethral diverticulum (UD), a small, hidden pouch in the urethral wall that traps urine and causes many uncomfortable symptoms. With today’s improved imaging tests and increased awareness about the condition, urethral diverticulum is more common than once thought.
At Tower Urology, our urogynecology specialists are trained to recognize and treat even the most elusive lower urinary tract symptoms, using state-of-the-art diagnostics and expert surgical treatment options tailored to your needs.
What is a urethral diverticulum?
A urethral diverticulum is an outpouching, or sac-like structure, that forms in the wall of the female urethra, the tube-like structure that carries urine from the bladder to the outside of the body. It typically bulges into the anterior vaginal wall, or the front wall of the vagina. It can collect urine during voiding (peeing) and slowly leak afterward, causing pain, infection, and irritation.
Although historically considered rare, the incidence of female urethral diverticula has increased as more cases are detected through improved imaging techniques, such as magnetic resonance imaging (MRI), voiding cystourethrography, and urethrography. However, many remain undiagnosed due to subtle symptoms that are attributed to other female conditions.
What are common urethral diverticulum symptoms?
Many women have vague lower urinary tract symptoms that are easy to attribute to other conditions, which is why urethral diverticulum is often overlooked or misdiagnosed. Common symptoms include:
- Recurrent urinary tract infections (UTIs).
- Dysuria (painful urination).
- Postvoid dribbling (leaking a small amount of urine shortly after you finish urinating, often when you stand up, as urine trapped in the pouch drains out) or continuous leaking.
- Dyspareunia (pain with intercourse).
- Hematuria (blood in the urine).
- Urinary retention or difficulty starting the flow.
- A vaginal mass or painful bulge along the anterior vaginal wall.
- Stress incontinence or unexpected urine leakage.
The classic symptom trio of dysuria, dyspareunia, and dribbling often strongly suggests a UD, but not every woman experiences all three.
What causes a urethral diverticulum?
The exact cause of a urethral diverticulum isn’t always clear, but most are thought to begin with an infection or blockage of the periurethral glands, small glands that line the urethra and help keep it lubricated..
But when these glands become infected, they can swell, form an abscess, and rupture into the urethral wall, creating a diverticular sac. Once this sac forms, it may fill with urine, leading to recurring infections, inflammation, and eventual growth.
Other risk factors include:
- Pelvic trauma or childbirth injuries.
- Use of a catheter.
- Prior endoscopic procedures.
- Hormonal changes.
- Prior urethral stricture or inflammation.
Why urethral diverticulum is often misdiagnosed
Many women with a urethral diverticulum spend months or even years being treated for something else before they get the right diagnosis. The pouch is small, hidden inside the urethral wall, and its symptoms overlap with several far more common conditions.
Conditions that urethral diverticulum is frequently mistaken for include:
- Recurrent urinary tract infections. Each infection may clear with antibiotics, but the trapped urine in the pouch allows bacteria to return.
- Interstitial cystitis (painful bladder syndrome), because both can cause pelvic pain, burning, and urgency.
- Overactive bladder or stress incontinence, when leakage is the main complaint.
- Skene’s gland cysts or other vaginal wall cysts, which can feel similar during an exam.
- Vulvar or pelvic pain conditions, when pain with intercourse is the main symptom.
A standard urinalysis or routine pelvic exam can easily miss a diverticulum, especially a small one or one that is empty at the time of the exam. If you have recurring UTIs, unexplained post-void dribbling, pain with intercourse, or a tender spot along the front wall of the vagina, ask your doctor whether a urethral diverticulum has been ruled out. An evaluation by a urologist with specialized training in female pelvic medicine, including MRI when appropriate, is often what finally provides answers.
How is it diagnosed?
Diagnosis starts with a thorough physical examination. A trained urologist may feel a tender area or bulge in the vaginal wall. To confirm the diagnosis and map out the diverticulum’s location, we use various methods:
- MRI (magnetic resonance imaging) – highly sensitive and often preferred for assessing size and location.
- Voiding cystourethrogram (VCUG) – shows how urine flows and where it pools.
- Urethrography – a detailed X-ray of the urethra.
- Cystoscopy or urethroscopy – using a tiny camera to examine the urethra for lesions or abnormal openings.
- Urodynamic testing – to assess bladder and urethral function.
Our Tower urogynecology team carefully selects imaging techniques based on your anatomy and symptoms to ensure an accurate, complete picture.
Urethral diverticulum treatment
Most patients need surgical excision to resolve the problem entirely. The standard approach is a urethral diverticulectomy, a reconstructive surgery that involves removing the diverticulum and repairing the urethral and surrounding fascia in layers.
Depending on the case, your surgeon may use a transvaginal (through the vagina) or transurethral (through the urethra) technique. For larger or complex diverticula, we may also use the Martius flap. This procedure involves taking a graft of healthy fat and tissue from the labia to reinforce the repair and reduce complications.
Our surgeons specialize in this delicate procedure, reducing the risk of complications like stress urinary incontinence, urethral stricture, or recurrence. Most women return home the same day with a catheter to help the area heal over 1–2 weeks. Postoperative follow-up is crucial for monitoring healing and preventing long-term issues.
This PDF has more information about the urethral diverticulectomy procedure.
Urethral diverticulum and urinary incontinence
Urinary leakage and urethral diverticulum often go hand in hand, but the type of leakage matters.
Post-void dribbling is caused by the diverticulum itself. Urine collects in the pouch during urination and then drains out after you finish. This type of leakage usually improves once the diverticulum is removed.
Stress urinary incontinence (SUI), leakage when you cough, sneeze, laugh, or exercise, is a separate problem that can exist alongside a diverticulum. Because the two can look similar, a careful evaluation before surgery is important. Urodynamic testing helps show how your bladder and urethra are working and whether stress incontinence is present.
If you have both conditions, your surgeon will discuss whether to treat them at the same time or separately. When an incontinence procedure is performed at the same time as a diverticulum repair, many specialists prefer a sling made from your own tissue rather than synthetic mesh, to lower the risk of complications in the healing area.
In some women, stress incontinence can appear for the first time after diverticulum surgery. This is one reason it is important to choose a surgeon experienced in both urethral reconstruction and urinary incontinence treatment so both issues can be addressed in a single, coordinated plan.
Can UD go away on its own?
No, a urethral diverticulum does not go away on its own. Once the pouch forms, it stays, although symptoms can come and go as it fills, drains, or becomes infected. Small diverticula that cause no symptoms are sometimes monitored rather than treated right away. For women with recurring infections, pain, or leakage, surgical repair is usually recommended because delaying treatment can allow infections to recur and the pouch to grow.
Cancer within a urethral diverticulum is rare, but it can occur. This is one reason any diverticulum should be properly evaluated and followed by a specialist, even if you decide not to have surgery right away.
The sooner a urethral diverticulum is correctly diagnosed, the sooner you can find relief and protect your long-term urinary health.
Why turn to Tower Urology for women’s urologic care in Los Angeles?
Urethral diverticulum in women can be complex, frustrating, and often misunderstood. But with the right diagnosis and treatment, relief is possible. At Tower Urology, every woman deserves expert, respectful care delivered with empathy, privacy, and precision.
Our physicians understand the sensitive nature of conditions like recurrent UTIs, pelvic floor dysfunction, and female urethral diverticula. We take the time to truly listen, evaluate all symptoms, and personalize your treatment plan with your comfort and long-term health in mind. From diagnosis to surgical treatment and postoperative follow-up, you’ll be supported every step of the way.
Our approach is personal—we treat patients, not just pathology.
We invite you to establish care with Tower Urology
Tower Urology is a proud affiliate of Cedars-Sinai Medical Center, ranked #1 in California and #2 nationwide by U.S. News & World Report. This partnership reflects our ongoing commitment to providing the highest quality urologic care alongside some of the country’s best urologists and urogynecology specialists.
We are conveniently located to serve patients throughout Southern California, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include treatment for pelvic organ prolapse, menopause/hormone management, chronic pelvic pain syndrome in women, shockwave therapy for pelvic pain, interstitial cystitis, lichen sclerosis and planus, urethral diverticulum, urethral stricture disease, urinary fistulas, and vaginal mesh complications.
Urethral Diverticulum FAQs
Urethral diverticulectomy is a urethral diverticulum surgery where the diverticulum is removed and the urethra is rebuilt using reconstructive techniques.
You’ll go home with a catheter for 1–2 weeks and return for follow-up visits. Most women feel relief and improved bladder function after healing.
We believe patient experience speaks for itself. You can explore real stories and outcomes from women treated at our Los Angeles practice on our women’s health testimonials page.
Our urologist may feel a tender bulge in the vaginal wall during an exam. MRI, the most accurate imaging test, confirms the diagnosis and maps the pouch’s size and location. Other tests may include cystoscopy, a voiding cystourethrogram, or urodynamic testing.
Most women have significant relief from pain, leakage, and recurrent infections. A catheter usually stays in place for one to two weeks while the area heals, and follow-up visits monitor recovery. In experienced hands, success rates are high and recurrence is uncommon.
A urethral diverticulum is not usually an emergency, but it should not be ignored. Left untreated, it can cause recurring infections, abscesses, stones within the pouch, and worsening pain or leakage. Rarely, cancer can develop within a diverticulum, which is why proper evaluation and follow-up with a specialist are important.
Post-void dribbling means leaking a small amount of urine shortly after you finish urinating, often when you stand up or move. With a urethral diverticulum, it happens because urine collects in the pouch while you urinate and then slowly drains out afterward.
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Imaging of Female Urethral Diverticulum: An Update
https://pubs.rsna.org/doi/10.1148/rg.287075076 -
Urethral Diverticula – ScienceDirect
https://www.sciencedirect.com/science/article/abs/pii/S0301211599002109 -
Urethral Diverticulum: A Systematic Review
https://pubmed.ncbi.nlm.nih.gov/31258943/
Sources
Imaging of Female Urethral Diverticulum: An Update
https://pubs.rsna.org/doi/10.1148/rg.287075076
Urethral Diverticula – ScienceDirect
https://www.sciencedirect.com/science/article/abs/pii/S0301211599002109
Diagnosis and Management of Female Urethral Diverticulum
https://pubmed.ncbi.nlm.nih.gov/22453220/
Urethral Diverticulum: A Systematic Review
https://pubmed.ncbi.nlm.nih.gov/31258943/
