Urethral diverticulum

　　Urethral diverticula can be classified into congenital and acquired types, and the specific pathogenic factors are as follows:

　　One, congenital urethral diverticulum, also known as primary urethral diverticulum or true diverticulum, the exact cause is still unclear, and it may be caused by the following 4 reasons.

　　1. Congenital maldevelopment of the urethral corpus spongiosum: The ventral tissue of the urethra is thin, and the pressure of urine flow causes the anterior wall to expand and protrude, forming a diverticula.

　　2. Urethral groove failure to fuse: Like hypospadias, there is a partial defect in the urethral wall, but the surrounding tissue develops well, forming a diverticula.

　　3. Cellular clusters remaining on the side of the urethra during embryogenesis: These develop into cystic structures and then communicate with the urethral groove, forming diverticula.

　　4. The distal part of the diverticula often has urethral stricture: Therefore, the role of urethral stricture at the distal part of the Campbell diverticula in the formation of diverticula. If there is also a duplicated urethra at the same time with distal stricture, the tip is blind, the accessory urethra will gradually dilate to form a diverticula.

　　Secondly, acquired urethral diverticula, also known as secondary urethral diverticula or pseudodiverticula, have the following three causes.

　　1. Urethral trauma: This is the most common cause. After urethral injury, if the surrounding hematoma, extrinsic urine, and infection are not drained in time and thoroughly, the surrounding tissue becomes organized and forms diverticula.

　　2. Urethral calculus: Calculi stay in the urethra, compressing it, leading to local necrosis and rupture, forming diverticula.

　　3. Periurethral abscess: Periurethral abscesses can break through the urethra to form diverticula. The pathogenic bacteria are mixed infections of Gram-negative bacilli, and there are reports of schistosomiasis causing them in Egypt. Diverticula located in the prostate are often caused by prostatic abscesses and are relatively common in clinical practice.

　　Diverticula with large openings generally only cause urinary tract obstruction. Due to increased intracystic pressure, glomerular filtration rate decreases, further causing a decrease in urine output. Narrow-neck diverticula, due to poor drainage, may develop infections and calculi. If the diverticula become secondarily infected, there may be local pain, redness, and tenderness, and pus-containing urine may be discharged when pressing on the diverticula. When the diverticula penetrate the skin, urinary fistulas may form. When complications occur with calculi, the diverticula become hard, and a sensation of sand and gravel can be felt when touched.

　　Small diverticula have no clinical symptoms and are not easy to be discovered. When the diverticula are larger, the accumulated infectious residual urine in the diverticula often leads to recurrent urinary tract infections, causing frequent urination, urgency, and dysuria. Larger diverticula may have local distension and pain during sexual intercourse. Some patients may present with dribbling urine, that is, a small amount of urine is involuntarily dripping out after standing up after urination. Larger diverticula can be palpated as cystic masses in the anterior vaginal wall during physical examination, often accompanied by tenderness. Those with calculi may have a sensation of stones.挤压肿块，可发现尿道口有混浊尿液或脓液溢出。

　　The true cause of congenital urethral diverticula is not yet clear, so there is no effective preventive measure. The focus is on early detection, early diagnosis, and early treatment. During pregnancy, it is important to strengthen nutrition, eat more fruits and vegetables to supplement sufficient vitamins, and promote the benign development of the fetus. Secondary urethral diverticula should focus on preventing urinary tract infections.

　　The examination items for urethral diverticula include urine examination, pathogen detection, and urethral angiography, etc. Urethral angiography can show diverticula, and voiding cystourethrogram should be performed for posterior urethral diverticula. Cystoscopy is also helpful for diagnosis, but attention should be paid to avoid puncturing the diverticula. Other examinations such as CT and MRI after urethral and bladder angiography can also be clarified.

　　The dietary taboos for urethral diverticula are as follows:
　　1. Suitable Foods
　　Grain and bean selection: Alkaline stones are suitable for foods such as grains, starches, peanuts, peas, etc.; acidic stones are suitable for foods such as brown rice, corn, millet, barley, wheat, soybeans, and soy products.
　　Meat, egg, and milk selection: Alkaline stones are suitable for foods such as lean pork, oysters, scallops, chicken, eggs, etc.; acidic stones are suitable for foods such as eggs, milk, and chicken.
　　Vegetable selection: Alkaline stones are suitable for vegetables, and it is advisable to choose those with sufficient water content such as cucumbers, luffa, and winter melon; acidic stones are suitable for foods such as lotus root, radish, eggplant, winter melon, onion, mushrooms, watermelon, potatoes, cucumbers, etc.
　　Fruit selection: Alkaline stones are suitable for foods such as watermelons, pears, apples, plums, etc.; acidic stones are suitable for foods such as strawberries, bananas, oranges, persimmons, grapes, etc.
　　2. Foods to Avoid
　　Alkaline stones should avoid potatoes, beets, spinach, asparagus, rapeseed, sauerkraut, green beans, celery, cucumbers, carrots, shrimp paste, seaweed, and fish such as hairtail; cocoa, coffee, chocolate, strong black tea, walnuts, plums, oranges, etc., are high oxalate foods and should not be eaten in large quantities. High malic acid foods such as green grapes, citric acid, mushrooms, walnuts, spinach, tomatoes, pears, etc., should also not be eaten in large quantities. Acidic stones should avoid pork, beef, duck, goose, animal internal organs, salted or fried foods, crucian carp, sardines, whitebait, dried meat, various meat soups, broths, clams, crabs, etc.; vegetables such as spinach, various beans, cauliflower, asparagus, and mushrooms; wine, strong tea, coffee, cocoa, etc.; strong spices and seasonings.

　　The treatment of urethral diverticula should be completely excised in principle. For those with small diverticular orifices, the urethra is sutured after excision; for those with wide orifices, the urethra is reconstructed with the Cecil urethroplasty after excision of the diverticula to compensate for the urethral defect. For those with difficulty in excision, most of the diverticula are excised, and the remaining parts are inverted sutured. Simple incision and drainage often leads to recurrent urinary fistula. All types of diverticulectomies require suprapubic cystostomy or perineal urethrostomy, and the stoma tube is removed after the urethra is completely healed. Currently, there is a method of treating the anterior and posterior lips of the diverticular orifice through urethral incision, which can immediately relieve obstruction.