From the Guidelines
The treatment of a urethral diverticulum typically involves surgical excision, particularly for symptomatic cases, with the standard approach being transvaginal diverticulectomy, as supported by the most recent and highest quality study 1. The goal of treatment is to relieve symptoms, such as recurrent UTIs, dyspareunia, post-void dribbling, and periurethral pain, and prevent complications like stone formation or malignant transformation. Before surgery, patients should undergo imaging studies, with MRI being the optimum imaging modality for assessment of the structure and complexity of urethral diverticula, allowing for accurate diagnosis and improved surgical planning 1. Some key points to consider in the treatment of urethral diverticulum include:
- Preoperative antibiotics are recommended if infection is present, typically with fluoroquinolones like ciprofloxacin 500mg twice daily for 7-14 days.
- Postoperatively, patients require urethral catheterization for 7-14 days to allow proper healing.
- Potential complications include urinary incontinence, urethrovaginal fistula formation, and recurrence in 5-20% of cases.
- For small, asymptomatic diverticula, conservative management with observation may be appropriate. It's worth noting that the study on male urethral stricture 1 is not directly relevant to the treatment of urethral diverticulum, and therefore, the recommendation is based on the more relevant and recent study 1.
From the Research
Treatment Options for Urethral Diverticulum
- Surgical excision is the definitive treatment of urethral diverticulum (UD) and the only reasonable surgical option for treating midurethral and proximal UD 2
- Transvaginal resection of the UD ± reconstruction was performed in the majority of patients (84%) 3
- Marsupialisation (3.8%) and transurethral endoscopic unroofing (2.0%) are other surgical techniques used to treat UD 3
- Various other surgical techniques were reported in 181 out of 1,858 cases (9.7%) 3
Surgical Management
- The mainstay treatment of posterior urethral diverticulum (PUD) is the open surgical approach, but minimally invasive surgical approach (MIS) can also be used 4
- Transvaginal diverticulectomy is the treatment of choice for female urethral diverticulum (UD) 5
- Concomitant treatment of preexisting stress incontinence with autologous fascial pubovaginal sling can be used at the time of diverticulectomy 6
Postoperative Complications
- Postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur after transvaginal diverticulectomy 5
- De novo SUI can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection 5