SUFU 2021: Diagnostic and Surgical Management of Female Urethral Diverticulum: The Challenge of an Infrequent Pathology

( The aim of this study is to present a case series of patients who underwent diagnosis and subsequent surgical management of urethral diverticulum (UD). A retrospective study of a prospective database of our urogynecology unit between 2016-2019 identified sixteen patients.

The median age was 51.5 years (IQ: 44.2-58.7), 8 patients were sexually active, median follow-up was 10.1 months. 2 patients exhibited the classic triad of symptoms (dribbling, dysuria, dyspareunia), and 8 patients presented at least one of these symptoms. The most frequent symptom was vaginal mass (n=10) and urinary incontinence (UI) (n=9). Less frequent symptoms were incomplete emptying sensation (n=2) and recurrent urinary tract infections (UTI) (n=2). A physical exam showed an increase in vaginal volume (n=12), purulent discharge of the mass (n=7), and stress urinary incontinence (SUI) (n=5). A horseshoe UD was found in 5 patients.

The surgical procedure was a vaginal diverticulectomy which consisted of an inverted U vaginal incision, a horizontal periurethral plane development, a dissection of the UD until the identification of the communication with the urethra, and the resection of the UD. The closure was performed in at least 3 planes. A fascial sling was placed in 4 patients for concomitant SUI treatment. A Martius flap was performed in 2 patients, one of them diagnosed with clear cell adenocarcinoma in the UD. There were no reports of intraoperative complications. 3/5 patients with SUI without sling placement had persistent SUI. One of them had a recurrence of UD. 2 patients presented de novo UI that didnĀ“t affect the quality of life (QoL). 1 patient with a fascial sling had voiding dysfunction symptoms. There have been no cases of the fistula or de novo dyspareunia. All patients reported feeling satisfied with the surgery. The possibility of malignancy in the UD is relevant, whose prevalence can be as high as 9% of cases of operated UD.

Presented by: Fernanda Santis-Moya, Marcelo Mass-Lindenbaum, Eitan Dines, Yael Dimonte-Bendov, Miriam Cohen-Vaizer, Ricardo Valderrama, Santiago, Chile

Written by: Diane K. Newman, DNP, CRNP, FAAN, BCB-PMD, Nurse Practioner and Co-Director, Penn Center for Continence and Pelvic Health Adjunct Professor of Urology in Surgery during the 2021 Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (SUFU) Winter Meeting