A 42-year-old woman complains of recurrent urinary tract infections, dyspareunia and post-void dribbling. Examination reveals a tender, fluctuant 2 cm swelling in the anterior vaginal wall at the level of the mid-urethra, which discharges pus on compression. What is the most likely diagnosis?
- A Urethral diverticulum ✓
- B Gartner duct cyst
- C Skene gland abscess
- D Anterior vaginal wall cystocele
Correct answer: A. Urethral diverticulum
Explanation
The classic triad of dysuria, dyspareunia and dribbling (the three Ds), together with a mid-urethral anterior vaginal wall swelling that discharges on compression, defines a urethral diverticulum arising from the periurethral glands. Recurrent UTIs occur because of stasis within the pouch. B Gartner duct cyst lies higher on the lateral vaginal wall and is a remnant of the mesonephric duct. B Skene gland abscess sits at the external meatus, and a cystocele is a diffuse bulge without purulent discharge.
Reference: Campbell-Walsh Urology, 12th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.