Anatomy

Anatomy

The female urethra is around 4 /uni00A0 cm long, extending from the bladder neck to the meatus. The entire length of female urethra is sphincter active. There is extra support from the surrounding pelvic floor musculature. - Abnormalities of the female urethra include: /uni25CF caruncle; /uni25CF stricture; /uni25CF diverticulum; /uni25CF papillomas; /uni25CF carcinoma. Caruncle This is seen in elderly women. It presents as a soft, raspberry- like mass about the size of a pea. It is actually the prolapsed urethral mucosa at the 6 o’clock position ( Figure 85.11 ). Occasionally , there is bleeding. If required it is treated by excision and diathermy coagulation of the base of the stalk. Stricture Urethral stricture is uncommon in women. The aetiology includes urethritis, trauma associated with a prolonged or di ffi cult labour or instrumentation. Urinary retention is an occasional consequence and is usually chronic. The stricture is initially managed by urethral dilatation. Urethroplasty ). with buccal mucosa augmentation is advocated for recurrent - strictures. Diverticulum A female urethral diverticulum may be congenital or caused by rupture of a distended and infected paraurethral gland or by injury of the urethra during childbirth. Urine within the diverticulum becomes infected, causing local pain and repeated bouts of cystitis. Purulent urine is discharged if the urethra is compressed with a finger placed in the vagina. Diagnosis is by MRI or by transvaginal ultrasound. Excision of -

External urethral External opening urethral opening Urethral caruncle Vagina Anus Figure 85.11 A urethral caruncle.

the diverticulum through the anterior vaginal wall is e ff ective, but care must be taken not to damage the urethral sphincter ( Figure 85.12 ). Papillomas/condyloma acuminata Condyloma acuminata (also known as anogenital warts) are a common sexually transmitted disease caused by human papillomavirus (HPV) types 6 and 11. Warts are small, skin coloured or pink growths and may be smooth and flat or raised with a rough texture. They are usually located on the labia, at the opening of the vagina or around or inside the anus. Most women with warts do not have an y symptoms at all. Less commonly , there may be itching, burning or tenderness in the genital area. The treatment options vary depending on the size. They include local application of podophyllotoxin or imiquimod; surgical treatments include cryotherapy , electrocautery , exci sion and laser therap y . Carcinoma of the urethra This occurs twice as often in women as in men. Whether a caruncle can become malignant is disputed, but caruncles and tumours often occur close together. Malignant swellings of the urethra feel harder than benign ones. Treatment is by radiotherapy or radical surgery . The overall prognosis is poor.

Figure 85.12 (a) Magnetic resonance imaging showing a diverticulum arising from the posterior wall of the urethra. It appears bright owing to accumulated urine and infected material (arrow). (b) Intraoperative picture of a urethral diverticulum in a female (arrow). (c) Endoscopic view of the diverticulum. (c)