Transvaginal diverticulectomy for urethral diverticulum in a young female: case report

TL;DR

A 36-year-old woman with a rare urethral diverticulum was successfully treated with transvaginal surgery after years of unexplained urinary symptoms.

Contribution

This case emphasizes the importance of early diagnosis and proper surgical technique for managing urethral diverticulum in women.

Findings

Urethral diverticulum can present with nonspecific symptoms, leading to delayed diagnosis.

Transvaginal diverticulectomy is an effective treatment when performed with meticulous technique.

Early recognition and imaging are crucial for successful management of this rare condition.

Abstract

This case highlights the unique presentation of a 36-year-old woman with a urethral diverticulum (UD), a rare and under-recognized condition in women, diagnosed following a three-year history of lower urinary tract symptoms (LUTS) unresponsive to standard treatment and complicated by dyspareunia. Clinical examination revealed a tender anterior vaginal wall mass, and the diagnosis was confirmed by retrograde urethrocystography and magnetic resonance imaging (MRI), which revealed no additional complications. The patient underwent transvaginal diverticulectomy via an inverted U-shaped incision, with meticulous multi-layered closure of the periurethral fascia and vaginal wall. Postoperative recovery was uneventful, and the patient experienced complete resolution of symptoms. This case contributes to the scientific literature by underscoring the diagnostic challenge of UD due to its nonspecific symptoms and rarity, which often lead to delayed diagnosis and mismanagement. It emphasizes the importance of maintaining a high index of suspicion in women presenting with recurrent or persistent LUTS and dyspareunia. The successful surgical outcome further highlights the efficacy of transvaginal diverticulectomy as the gold-standard treatment, provided a meticulous technique is employed to minimize complications. The main takeaway from this case is the critical role of early recognition, thorough clinical evaluation, and imaging in diagnosing UD to ensure timely and effective management, ultimately improving patient quality of life.

Figures