Complex Female Urethral Diverticulum with Staged Urethral Reconstruction

S. Bajramovic

Introduction:

Urethral diverticulum (UD), whether congenital or acquired, represents a rare urological condition, usually presented with diverse and nonspecific clinical symptoms. Although the diagnosis of UD may be assumed by patient’s history and physical examination, appropriate radiological imaging is crucial for establishing the diagnosis. Treatment may include conservative management, however, surgical intervention represent current treatment of choice.

Materials and methods:

In this video, we present a case of a 34 years old female patient, with frequent urinary tract infections (UTIs) accompanied by purulent urethral discharge during the last three years. The patient was sexually active, and was not subjected to any previous gynecological interventions. In addition, she felt the swelling of vaginal wall, painful urination, and weak urinary stream. Physical examination indicated the presence of cystic formation on anterior vaginal wall, just below urethral meatus. MRI scans of urethra revealed one large, saddle bag UD and another, smaller UD.

Results:

After the diagnosis was established, we performed divetriculectomy, followed by urethral reconstruction (urethroplasty) using labia minora and surrounding tissue. Following the urinary catheter extraction, the patient was able to control the urination, having weak urinary stream. Instrumental dilatation of urethra was done periodically, although the effect was not long-lasting, and the patient still experienced the weak stream. Local findings were normal without any inflammation. After one year, repeated MRI findings did not show any recurrence of UD, so we performed urethroplasty, using buccal mucosa. Following catheter extraction after two weeks, the patient was able to urinate normally, maintaining high uroflow stream, without any disuric symptoms, or urinary leak.

Conclusion:

Individual approach to the patient and gradual resolution of the problem represent a key to treatment success.

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