Male urethral diverticula are rare, and most (80% to 90%) are acquired
. They may be caused by blockage of the periurethral glands into the urethral lumen (cavity) with epithelialization (regrowth of tissue) over the opening of the resulting periurethral cavity. In a man with paraplegia, as in our case, long-term or clean intermittent catheterization to eliminate urinary stasis (neurogenic bladder) may induce, in the long term, repeated trauma and infection injuring the urethral wall and causing stricture, fistula and, to a lesser extent, diverticulum
[2, 3]. In some cases, diverticula may also appear as a complication of an artificial urinary sphincter, and after urethral surgery. Diagnosis of urethral diverticulum may be delayed because of the non-specific lower urinary tract symptoms. Patients may complain of recurrent urinary tract infections, pelvic pain, incontinence, post-void dribbling, dysuria (burning or pain with urination), urinary frequency and urgency, nocturia, or feeling of incomplete bladder emptying
. The diverticulum could present as a perineo-scrotal mass if the size is extremely large. In differential diagnosis of a scrotal mass in a male with paraplegia, especially when a urinary tract infection is observed, epididymo-orchitis and urethro-scrotal abscess should also be suspected. Retrograde urethrography is the best diagnostic technique to confirm and characterize the diverticulum
. However, Goyal et al.
 have used transrectal sonography to diagnose congenital urethral diverticulum, but there is no recommendation of its routine use for acquired urethral diverticulum. Magnetic resonance imaging (MRI) is also useful because it can inform of the extent of the diverticulum, and of the involvement or not of the adjacent spongy tissue.
The most commonly reported associated complications are urinary tract infection, fistulas and stone formation in the diverticulum. Even adenocarcinoma has been reported to arise as a complication from urethral diverticulum.
On histopathological evaluation, acquired diverticula are generally lined by granulation tissue whereas congenital diverticula are lined by epithelia
The recommended treatment is surgical excision of the diverticulum and urethroplasty over a transurethral catheter. If the urethral defect is very large, then extragenital free grafts can be used. In some cases an endoscopic approach has been applied to small diverticula. After surgical treatment, there is no perioperative morbidity, and the long-term follow-up results can be marked by the recurrence of diverticulum, fistula formation and urethral stenosis
. The follow-up of our case report was uneventful after one year.