Kadın üretra divertikülü: 2 olgu sunumu

Year 2015, Volume: 10 Issue: 1, 45 - 48, 01.01.2015

Ahmet Bölükbaşı Kaan Bal Burak Özçift

Abstract

Kadın üretra divertikülü nadir olarak görülen bir patolojik durumdur ve üretral divertikül tanısı sıklıkla gecikebilmekte ya da atlanabilmektedir. Alt üriner sistemi de içeren, sıkıntı veren ve kronik semptomlarla karakterizedir. Üretral divertikülün klasik bulguları ağrılı işeme, ağrılı cinsel ilişki, idrar yaptıktan sonra damlama, zor işeme ve vajinal kitle olarak tanımlanmıştır. Klinik şüphe durumunda ayrıntılı bir fizik muayane ve radyolojik görüntüleme yöntemleri tanıyı koymada yardımcı olur.Bu makalede 38 ve 26 yaşındaki iki kadın hasta sunuldu. Her ikisinde de işeme güçlüğü, tam boşaltamama hissi, yanma, sık tekrarlayan üriner enfeksiyon, sistizm, ağrılı cinsel ilişki, vajinal kitle gibi benzer şikayetler mevcuttu. Fizik muayene ve radyolojik görüntüleme yöntemleri vajinal ultrason, üretrografi ile tanı konuldu. Genel anestezi altında transvajinal yolla divertikül eksize edildi. Cerrahi tedavi vajinal yaklaşımla ve ciddi üretral hasarlanma olmadan gerçekleştirildi. Üriner drenaj 10 gün sistofiks ile sağlandı. Postoperatif dönemde komplikasyon gelişmeyen hastanın şikayetleri tamamen düzeldi

Keywords

divertikül , kadın , üretra , tanı , tedavi

Female urethral diverticulum: 2 case reports

Abstract

Female urethral diverticulum is rarely seen pathologic entity and diagnosis of urethral diverticulum in female patients is often delayed or missed. Associated with distressing and chronic symptoms involving the lower urinary tract. The classic presentation of urethral diverticulum has been described as dysuria, dyspareunia, dribbling, difficult urination and vaginal mass. In case of clinical suspicion combined with thorough physical examination and radiological investigations helps for diagnose. In this article, two cases of 38 and 26 years old women are presented. They had same symptoms with sense of residual urine, dysuria, recurrent urinary tract infection, cystism, dyspareunia and vaginal mass. Diagnosis were performed by radiological images vaginal ultrasound, uretrography and physical examination. Under general anesthesia the diverticulum was extracted transvaginal way. Surgical management was accomplished vaginally without significant urethral disruption. Urinary drainage was achieved with cystofix for ten days. No complication developed and all the symptoms dissappeared completely postoperatively

Keywords

diverticulum , female , urethra , diagnosis , treatment

References

• Hey W: Practical Observations in Surgery. Philadelp- hia: James Humphries Publishers, 1805.
• Davis HJ, Cian LG. Positive pressure urethrography: A new diagnostic method. J Urol 1952; 68:611-16.
• Lang EK, Davis HJ. Positive pressure urethrography: A ro- entgenographic diagnostic method for urethral diverticula in the female. Radiology 1959; 72:401-5.
• Davis HJ, TeLinde RW. Urethral diverticula: An assay of 121 cases. J Urol 1958;80:34-39.
• McNally A. Diverticula of the female urethra. Am J Surg 1935; 28:177-81.
• Lee RA. Diverticulum of the urethra: Clinical presentation, diagnosis, and management. Clin Obstet Gynecol 1984; 27:490-98.
• Ganabathi K, Leach GE, Zimmern PE, et al. Experience with the management of urethral diverticulum in 63 wo- men. J Urol 1994; 152:1445-52.
• Klyszejko C, Ilnicki W, Klyszejko D, et al. Development of a urethral diverticulum after forceps delivery. Ginekol Pol 1985; 56:766-9.
• Young GPH, Wahle GR, Raz S. Female Urethral Diverticu- lum. Philadelphia: W.B. Saunders; 1996; p. 477-89.
• Lee JW, Fynes MM: Female urethral diverticula. Best Pract Res Clin Obstet Gynaecol 2005;19:875-93.
• Vakili B, Wai C, Nihira M. Anterior urethral diverticulum in the female: Diagnosis and surgical approach. Obstet Gynecol 2003;102:1179-83.
• Rovner ES, Wein AJ. Diagnosis and reconstruction of the dorsal or circumferential urethral diverticulum. J Urol 2003; 170:82-86.
• Wang HH, Wu YC, Liu CH, Su TF, Huang GS, Wu CJ. Fe- male urethral diverticulum. IBJU 2013; 39:597-598.
• Stewart M, Bretland PM, Stidolph NE. Urethral diverticula in the adult female. Br J Urol 1981;53:353-9.
• Lee TG, Keller FS. Urethral diverticulum: Diagnosis by ult- rasound. AJR Am J Roentgenol 1977;128:690-91.
• Riyach O, Ahsaini M, Tazi MF, Mellas S, Stuurman-Wie- ringa R, Khallouk A, et al. Female urethral diverticulum: cases report and literature. Ann Surg Innov Res 2014;1750- 1164.
• Ockrim JL, Allen DJ, Shah PJ, Greenwell TJ. Atertiary ex- perience of urethral diverticulectomy: Diagnosis, imaging and surgical outcomes. BJU Int 2009;103:1550-4.
• Lorenzo AJ, Zimmern P, Lemack GE, et al. Endorectal coil magnetic resonance imaging for diagnosis of urethral and periurethral pathologic findings in women. Urology 2003;61:1129-33.
• Davis BL, Robinson DG. Diverticula of the female urethra: assy of 120 cases. J Urol 1970;104:850-3.
• Peters W 3rd, Vaughan ED Jr. Urethral diverticulum in the female. Etiologic factors and postoperative results. Obstet Gynecol 1976;47:549-52.
• Leach GE, Schmidbauer CP, Hadley HR, et al. Surgical treatment of female urethral diverticulum. Semin Urol 1986;4:33-42.
• Faydacı G, Tarhan F, Eryıldırım B, et al. Kadın üretra di- vertikülü ve taşları. Türkiye Klinikleri J Gynecol Obst 2008;18:331-335.