Complete removal of the urethral diverticulum, corresponding to a sacciform eversion of the urethral mucosa.
There is no single surgery that can correct all cases of urethral diverticulum. The various techniques proposed can be carried out with an open surgical approach or with an endoscopic approach.
The classic approach consists in a complete removal of the diverticulum, through exposure and mobilization of the diverticular sac with an incision made in the woman at the level of the vagina and in the man at the level of the skin that covers the diverticular eversion, with subsequent complete excision of the diverticulum itself. This surgical approach allows the execution of the histological examination on the diverticulum wall, since cases of neoplasia in the diverticulum have been described, even though rare.
At the end of surgery, a suprapubic catheter or urethral catheter, or both, and a vaginal swab soaked in antibiotic solution are placed in the woman.
Another option in men as well as in women, is a transurethral incision of the diverticular link (endoscopic intervention by Lapides), which opens the diverticulum orifice transforming it from a narrow neck into a wide neck diverticulum with the aim of allow a better drainage (endoscopic diverticulectomy).
In women it is also possible to intervene with a transvaginal incision using a technique of marsupialization (surgical intervention according to Spence and Duckett); in this case an incision is made from the external orifice up to the diverticulum, then suturing the mucosa of the diverticular sac to the vaginal one.
Both these interventions must be reserved, in women, in diverticula very close to the external urethral orifice; they imply the placement of a catheter for 48 hours and can be burdened by manifestations of postoperative incontinence.
Type of anesthesia:
general or local.
antibiotic prophylaxis is useful.
in women the vaginal swab is generally removed on the first postoperative day; from 3 to 7 days after the operation the ureteral catheter is removed and, after the absence of urethro-vaginal fistula is asssessed, the epicistostomy is removed. In men the urethral catheter can be removed in the 6th-7th day.
in women, bleeding can occur in the form of abundant dripping, especially if an active infection coexists: a vaginal swab is generally sufficient to control this bleeding.
We can observe cases in which it is difficult to close the incisions due to poor tissue quality or significant inflammation; in situations like this, in women, some fat taken from the big lip can be interposed between urethra and vagina (Martius technique).
infections, bleeding, recurrence, urethral stenosis, and, in women, uretrovaginal fistula and strain urinary incontinence.
the first outpatient check will be performed after 15-20 days (before it is needed); the next will be decided on the basis of the findings and essentially in order to exclude complications.