V2-11: Excision of urerthral diverticulum with rectus fascia sling

Video

Introductions and Objectives
The estimated prevalence of urethral diverticulum (UD) in adult women is between 0.6% to 6%. The condition is usually diagnosed between the ages of 20 and 50. UD can present with storage and/or voiding lower urinary tract symptoms (LUTS), recurrent urinary tract infections (UTIs), vaginal mass, dyspareunia, hematuria, and/or urethral discharge. UD has a rare potential for malignant transformation and stone formation (up to 10%) if left untreated. Magnetic resonance imaging (MRI) represents the most accurate and informative imaging modality for diagnosis of UD. We present our technique of excision of UD and rectus fascia sling.

Methods
A 38-year-old female presented with recurrent UTIs, dysuria, urethral pain, and stress urinary incontinence. Vaginal exam revealed anterior vaginal wall mass. MRI and cystoscopy confirmed a horseshoe UD with incomplete septations. The diverticulum was completely excised. Rectus fascia sling was then inserted.

Results
Operative time was 2 hours. Estimated blood loss was less than 100ml. Foley catheter removed three weeks after surgery. Patient’s symptoms were resolved at two-month follow up.

Conclusions
Patients with UD can present with mixed LUTS. Vaginal excision of the UD is effective and safe procedure. Biological sling should be used instead of synthetic ones in the setting of the UD.

Funding: "none"