Editing Female Urethral Diverticulae (section)

==== Intervention ====

===== Indications =====

*'''<span style="color:#ff0000">Symptomatic patients, including those with dysuria, dyspareunia, refractory bothersome postvoid dribbling, recurrent UTIs, and pelvic pain, may be offered surgical excision.'''

===== Options (5): =====
# '''<span style="color:#ff0000">Excision (urethral diverticulectomy) with reconstruction (most common surgical approach)'''
# '''<span style="color:#ff0000">Marsupialization (transurethral and open)'''
# '''<span style="color:#ff0000">Endoscopic unroofing'''
# '''<span style="color:#ff0000">Fulguration'''
# '''<span style="color:#ff0000">Incision and obliteration with oxidized cellulose or polytetrafluoroethylene'''

====== Urethral Diverticulectomy ======

* '''Principles (8):'''
# Mobilization of a well-vascularized anterior vaginal wall flap(s)
# '''Preservation of the periurethral fascia'''
# Identification and excision of the neck, or ostium, of the UD
# Removal of entire UD wall or sac (mucosa)
# Watertight urethral closure
# Multilayered, nonoverlapping closure with absorbable suture
# Closure of dead space
# Preservation or creation of continence
* '''The location and competence of the urethral sphincters have important implications when considering surgical repair of urethral diverticulectomy because of the anatomic overlap of these two entities.'''
** '''Varying degrees of sphincteric compromise may exist prior to intervention because of the location of diverticulum relative to the proximal and distal urinary sphincter mechanisms, or sphincteric compromise may coexist with UD as a result of other factors.'''
*'''Technique'''
**'''Successful excision of a urethral diverticulum involves removal of the ostium that connects with the urethral lumen. This often results in direct visualization of the urethral catheter within the urethral lumen during surgery.''' The urethral defect is closed primarily with absorbable suture in a watertight fashion following completion of the removal of the sac.
*** Additional procedures such as buccal mucosal urethroplasty, Martius flap, or vaginal flaps are not necessary to close the urethra.
**'''<span style="color:#ff0000">Synthetic materials (e.g., mid-urethral polypropylene mesh) should not be used in an anti-incontinence procedure synchronously with urethral diverticulum surgery because of the potentially increased risk of urethral erosion and infection'''
* '''<span style="color:#ff0000">Adverse Events'''
*# '''<span style="color:#ff0000">Recurrent UTIs'''
*# '''<span style="color:#ff0000">Urinary incontinence'''
*# '''<span style="color:#ff0000">Recurrent urethral diverticulum'''
*# '''<span style="color:#ff0000">Urethrovaginal fistula (uncommon)'''
* '''Size of diverticulum does correlated with risk of recurrence following surgical repair'''
*Postoperatively, some patients will have persistence or recurrence of their preoperative symptoms.