A 30-year-old G3P3 is being evaluated for urinary urgency, frequency, and dysuria. She also reports post-void dribbling of urine and insertional dyspareunia. Her history is significant for recurrent urinary tract infections (UTIs) as a teenager, but no other medical problems. She has had three term spontaneous vaginal deliveries, and her last baby weighed over 9 lb. She recalls having a vaginal laceration requiring multiple sutures after delivery of that child. On pelvic examination, she has a 1-cm tender suburethral mass. Palpation of the mass results in expression of a small amount of blood-tinged purulent discharge.
Which of the following is the most likely cause of this patient’s problem?
A. Urethral polypUrethral diverticula occur in 3% to 4% of all women. Classic symptoms include urinary frequency, urgency, dysuria, hematuria, and dyspareunia. Patients often report a history of frequent UTIs, dribbling, or incontinence. A urethral diverticulum is often palpable as a tender mass on the anterior vaginal wall under the urethra. Although urethral polyps, eversion, fistula, and stricture may present with similar symptoms, there is no suburethral mass present on examination.