Urethral Diverticulum Diagnosis and Management

Diagnostic Considerations

Recurrent UTIs in a young woman with a tender anterior vaginal wall mass strongly suggests the presence of a urethral diverticulum, which is present in 30-50% of patients with this condition 1
MRI is the optimal imaging modality for assessment of urethral diverticula, allowing for accurate diagnosis and improved surgical planning 1

Pelvic MRI is the first-line imaging for suspected urethral diverticulum, providing excellent soft-tissue contrast for evaluating the structure and complexity of urethral diverticula 1
Pelvic MRI has been shown to alter surgical management in 15% of patients 1
Urine culture and sensitivity testing should be obtained before initiating treatment to guide antimicrobial therapy, with common causative organisms including E. coli, Proteus mirabilis, Klebsiella, Enterococcus faecalis, and Staphylococcus saprophyticus 2, 3

Antimicrobial therapy for acute UTI episodes while awaiting definitive management may include Nitrofurantoin 50-100 mg four times daily for 5 days, Trimethoprim-sulfamethoxazole 160/800 mg twice daily for 3 days, or Fosfomycin trometamol 3 g single dose 2

MRI is specifically preferred for suspected urethral diverticulum due to superior soft tissue contrast, compared to other imaging modalities like CT urography 1, 4