Kadında Üretral & Periüretral Hastalıklar
Özet
Kadınlarda üretral ve periüretral hastalıklar, nadir görülmelerine rağmen tanı güçlüğü ve yaşam kalitesi üzerindeki olumsuz etkileri nedeniyle önemli bir klinik gruptur. Üretral divertiküller en sık karşılaşılan patolojiler olup, idrar yolu enfeksiyonları, disparoni, işeme sonrası damlama ve pelvik ağrı gibi nonspesifik semptomlarla seyredebilir. Tanı çoğunlukla gecikir ve manyetik rezonans görüntüleme altın standarttır. Kesin tedavi cerrahi eksizyon ve rekonstrüksiyondur. Büyük üretral divertiküllerin cerrahileri ciddi komplikasyon riski taşır. Divertikül içinde taş veya malignite gelişme ihtimali %1–6 arasında bildirilmiştir. Bölümde ayrıca üretral mukozal prolapsus, üretral karünkül, Skene bezi kistleri, vajinal leiyomyomalar ve Gartner kanalı kistleri gibi diğer periüretral patolojiler de ele alınmaktadır. Bu lezyonlar genellikle asemptomatik olabilmekle beraber büyüdüklerinde işeme disfonksiyonu, ağrı veya vajinal şişkinlik ile yapabilirler. Tedavi yaklaşımı semptomatik olgularda cerrahi eksizyon, asemptomatik olgularda ise takip şeklindedir. Sonuç olarak, kadın üretral ve periüretral hastalıklarının yönetiminde erken tanı, multidisipliner yaklaşım ve ileri görüntüleme yöntemlerinin etkin kullanımı esastır. Gelecekte minimal invaziv cerrahi tekniklerin ve patofizyolojinin daha iyi anlaşılmasının, tedavi başarısını artırması beklenmektedir.
Referanslar
Cox L, Rovner ES. Bladder and Female Urethral Diverticula. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA eds. Campbell-Walsh-Wein Urology 12th edition. Elsevier, Philadelphia, PA, USA; 2021. Online edition.
Daneshgari F, Zimmern PE, Jacomides L. Magnetic resonance imaging detection of symptomatic noncommunicating intraurethral wall diverticula in women. J Urol. 1999;161:1259.
Rovner ES. Urethral diverticula: a review and an update. Neurourol Urodyn. 2007;26(7):972-7.
Harding C, Lapitan MC, Arlandis S, et al. Non-neurogenic Female LUTS. EAU Guidelines. Edn. presented at the EAU Annual Congress, Madrid 2025.
Rolef J, Rovner ES. Repair of Urethral Diverticula. In: Firoozi F ed. Female pelvic surgery. 2nd edn. Springer. Switzerland. 2023. 165-177.
Leach GE, Sirls LT, Ganabathi K, Zimmern PE. L N S C3: a proposed classification system for female urethral diverticula. Neurourol Urodyn. 1993;12(6):523-31.
Rufford J, Cardozo L. Urethral diverticula: a diagnostic dilemma. BJU Int. 2004;94(7):1044-7.
Birge O, Ozbey EG, Arslan D, Erkan MM, Demir F, Akgor U. Vulvar Epidermoid Cyst and Type 2 Radical Genital Mutilation. Case Rep Obstet Gynecol. 2015;2015:520190.
Romanzi LJ, Groutz A, Blaivas JG. Urethral diverticulum in women: diverse presentations resulting in diagnostic delay and mismanagement. J Urol. 2000;164(2):428-33.
Anderson-Mueller BE, Laudenschlager MD, Hansen KA. Epidermoid cyst of the clitoris: an unusual cause of clitoromegaly in a patient without history of previous female circumcision. J Pediatr Adolesc Gynecol. 2009;22(5):e130-2.
Kroese JA, van der Velde M, Morssink LP, et al. Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial. BJOG. 2017;124(2):243-249.
Thomas AA, Rackley RR, Lee U, Goldman HB, Vasavada SP, Hansel DE. Urethral diverticula in 90 female patients: a study with emphasis on neoplastic alterations. J Urol. 2008;180(6):2463-7.
Kujawa M, Biers S, Pakzad M, et al; BAUS Section of Female, Neurological and Urodynamic Urology. British Association of Urological Surgeons (BAUS) consensus document for the management of benign female urethral lesions. BJU Int. 2025;135(1):31-39.
(Blaivas JG, Flisser AJ, Bleustein CB, Panagopoulos G. Periurethral masses: etiology and diagnosis in a large series of women. Obstet Gynecol. 2004;103(5 Pt 1):842-7.
Dodson MK, Cliby WA, Keeney GL, et al. Skene's gland adenocarcinoma with increased serum level of prostatespecific antigen. Gynecol Oncol. 1994;55:304–307.
Davidson ERW, Barber MD. A Gartner Duct Cyst Masquerading as Anterior Vaginal Prolapse. Obstet Gynecol. 2017;130(5):1039-1041.
Cope AG, Laughlin-Tommaso SK, Famuyide AO, Gebhart JB, Hopkins MR, Breitkopf DM. Clinical Manifestations and Outcomes in Surgically Managed Gartner Duct Cysts. J Minim Invasive Gynecol. 2017;24(3):473-477.
Gaines N, Gupta P, Khourdaji AS, et al. Radiographic Misdiagnoses After Periurethral Bulking Agents. Female Pelvic Med Reconstr Surg. 2018;24(4):312-314.
Referanslar
Cox L, Rovner ES. Bladder and Female Urethral Diverticula. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA eds. Campbell-Walsh-Wein Urology 12th edition. Elsevier, Philadelphia, PA, USA; 2021. Online edition.
Daneshgari F, Zimmern PE, Jacomides L. Magnetic resonance imaging detection of symptomatic noncommunicating intraurethral wall diverticula in women. J Urol. 1999;161:1259.
Rovner ES. Urethral diverticula: a review and an update. Neurourol Urodyn. 2007;26(7):972-7.
Harding C, Lapitan MC, Arlandis S, et al. Non-neurogenic Female LUTS. EAU Guidelines. Edn. presented at the EAU Annual Congress, Madrid 2025.
Rolef J, Rovner ES. Repair of Urethral Diverticula. In: Firoozi F ed. Female pelvic surgery. 2nd edn. Springer. Switzerland. 2023. 165-177.
Leach GE, Sirls LT, Ganabathi K, Zimmern PE. L N S C3: a proposed classification system for female urethral diverticula. Neurourol Urodyn. 1993;12(6):523-31.
Rufford J, Cardozo L. Urethral diverticula: a diagnostic dilemma. BJU Int. 2004;94(7):1044-7.
Birge O, Ozbey EG, Arslan D, Erkan MM, Demir F, Akgor U. Vulvar Epidermoid Cyst and Type 2 Radical Genital Mutilation. Case Rep Obstet Gynecol. 2015;2015:520190.
Romanzi LJ, Groutz A, Blaivas JG. Urethral diverticulum in women: diverse presentations resulting in diagnostic delay and mismanagement. J Urol. 2000;164(2):428-33.
Anderson-Mueller BE, Laudenschlager MD, Hansen KA. Epidermoid cyst of the clitoris: an unusual cause of clitoromegaly in a patient without history of previous female circumcision. J Pediatr Adolesc Gynecol. 2009;22(5):e130-2.
Kroese JA, van der Velde M, Morssink LP, et al. Word catheter and marsupialisation in women with a cyst or abscess of the Bartholin gland (WoMan-trial): a randomised clinical trial. BJOG. 2017;124(2):243-249.
Thomas AA, Rackley RR, Lee U, Goldman HB, Vasavada SP, Hansel DE. Urethral diverticula in 90 female patients: a study with emphasis on neoplastic alterations. J Urol. 2008;180(6):2463-7.
Kujawa M, Biers S, Pakzad M, et al; BAUS Section of Female, Neurological and Urodynamic Urology. British Association of Urological Surgeons (BAUS) consensus document for the management of benign female urethral lesions. BJU Int. 2025;135(1):31-39.
(Blaivas JG, Flisser AJ, Bleustein CB, Panagopoulos G. Periurethral masses: etiology and diagnosis in a large series of women. Obstet Gynecol. 2004;103(5 Pt 1):842-7.
Dodson MK, Cliby WA, Keeney GL, et al. Skene's gland adenocarcinoma with increased serum level of prostatespecific antigen. Gynecol Oncol. 1994;55:304–307.
Davidson ERW, Barber MD. A Gartner Duct Cyst Masquerading as Anterior Vaginal Prolapse. Obstet Gynecol. 2017;130(5):1039-1041.
Cope AG, Laughlin-Tommaso SK, Famuyide AO, Gebhart JB, Hopkins MR, Breitkopf DM. Clinical Manifestations and Outcomes in Surgically Managed Gartner Duct Cysts. J Minim Invasive Gynecol. 2017;24(3):473-477.
Gaines N, Gupta P, Khourdaji AS, et al. Radiographic Misdiagnoses After Periurethral Bulking Agents. Female Pelvic Med Reconstr Surg. 2018;24(4):312-314.
