Urethral Diverticulectomy: Tips and Tricks. A Descriptive Retrospective Case Discussion With Surgical Video Presentation

Document Type

Conference Proceeding

Publication Date

9-2025

Publication Title

International Urogynecology Journal

Abstract

Introduction: Female urethral diverticulum is a rare condition. Symptoms include dysuria, postvoid dribbling, dyspareunia, recurrent infections, incontinence, palpable anterior vaginal wall mass. Surgical excision is the definitive treatment. A meticulous technique of dissection, tension free and watertight closure is required to have successful removal of diverticulum while minimizing immediate and long-term complications.

Objective: To present a case of a large stone-contained urethral diverticulum, describe the surgical technique of diverticulectomy, highlighting intraoperative key steps, surgical tips and tricks, and address perioperative care with outcomes discussion, supported by a detailed video presentation.

Methods: This is a descriptive video of of diverticulectomy with tips and tricks for educational and training purposes. A 35-year-old female presented with classical diverticulum triad: dysuria, postvoid dribbling, dyspareunia, and recurrent Urinary Tract Infections (UTIs). Preoperative MRI demonstrated a 2 cm urethral diverticulum originated from mid-distal urethra.. The procedure was performed in high dorsal lithotomy position under spinal anesthesia. An inverted U incision was made on anterior vaginal wall. The diverticulum was carefully dissected from the urethral wall. After diverticular sac excision, the urethral defect, periurethral fascia and vaginal wall were repaired with absorbable sutures in non-crossing suture-line fashion. Urinary diversion via Foley catheter was established and maintained till voiding urethrocystogram (VUCG) confirmed intact urethra.

Results: Successful entire excision of diverticulum with tension free multi-layer closure in non-crossing suture line fashion secured excellent postsurgical outcome. VUCG at 2 weeks confirmed intact urethra. Patient experienced complete resolution of her symptoms at 2, 6 and 12 weeks with no evidence of urinary incontinence and voiding dysfunction.

Conclusions: Diverticulectomy is a complex but effective procedure for treatment of female urethral diverticulum. A precise surgical approach is necessary to achieve optimal outcomes. The accompanying surgical video provides a valuable resource for surgeon to manage urethral diverticulectomy cases.

Volume

36

Issue

Suppl 1

First Page

S145

Last Page

S145

Comments

IUGA/EUGA (International Urogynecological Association/European Urogynaecological Association) Joint Meeting, June 18-21, 2025, Barcelona, Spain

DOI

10.1007/s00192-025-06257-0

ISSN

1433-3023

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