Congenital anterior urethral diverticulum (CAUD) is an uncommon condition in children. We describe 2 patients of CAUD who presented with ventral penile swelling; in one, the site of swelling was just proximal to corona which is quite rare. The diagnosis was made on USG and MCU. Both patients had normal renal function. Open diverticulectomy and primary repair was done in both patients.
Congenital anterior urethral diverticulum (CAUD) is an uncommon condition in children. CAUD is classified into saccular variety and globular variety, the former being more common than the latter [
A 12-year-old male presented with complaints of poor urinary stream and a swelling on the ventral aspect of penile urethra (Figure
Clinical photograph of the first patient showing a large diverticulum in the anterior urethra.
Micturating cystourethrogram showing a diverticulum in the anterior urethra depicting its proximal and distal lip as well as normally filled urinary bladder.
A six-month-male child presented with poor urinary stream and a cystic swelling at the penoscrotal junction (Figure
Clinical photograph of the second patient showing a diverticulum at the penoscrotal junction.
Congenital anterior urethral diverticulum (CAUD) may be found all along the anterior urethra but is usually located between the bulbous and the midpenile part. It is rare for AUD to be in distal urethra near the coronal level as in the present case1 of this paper. The embryology of AUD remains unclear. Various proposed hypotheses include a development defect of corpus spongiosum, cystic dilatation of the urethral glands, and sequestration of an epithelial nest after closure of the urethral folds. With a lack of a corpus spongiosum, a urethral dilatation in this region may develop into a diverticulum [
AUD may present at any age, from moment of birth upto adult life. Most children with this condition present with difficulty in micturition, dribbling of urine, poor urinary stream, or urinary tract infection. A careful history will reveal that the child never had a good urinary stream since birth, and a tell-tale sign is a cystic swelling at the penile urethra [
The diagnosis of AUD is usually made by MCUG or retrograde urethrogram. MCUG has the additional advantage of demonstrating proximal changes like megacystis, VUR, or other associated anomaly. VUR has been reported in 20% of patients with AUD [
The primary differential diagnostic conditions of AUD include anterior urethral valve (AUV), dilated Cowper’s gland ducts, and posttraumatic diverticulum. The presence of a penile or penoscrotal mass clinically and the proximal lip radiologically which is seen as an arcuate filling defect should readily distinguish the diverticulum from the valve. In addition, the proximal lip forms an acute angle with the normal caliber proximal urethra in AUD, whilst in AUV, it forms an obtuse angle [
Treatment of AUD depends on the size of the diverticulum and the degree of obstruction. Transurethral resection (TUR) with a paediatric resectoscope is the treatment of choice for small, well-supported diverticula wherein the distal obstructing lip is resected [
To summarise, in patients of AUD with large diverticula without any back-pressure changes, as in the present paper, open diverticulectomy with primary repair is recommended as this procedure carries good results, and it takes care of the redundant diverticular wall.
Anterior urethral diverticulum
Anterior urethral valves
Micturating cystourethrogram.