Excision of Urethral Diverticula
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Urethral diverticula result in most cases from inflammatory conditions of the periurethral glands. Most are the result of repeated infection and obstruction of the periurethral glands. Initially, a suburethral cyst is formed by both the inflammatory process of infection and by the pressures created within an obstructed periurethral gland. These cysts subsequently rupture into the urethral lumen. The resulting draining abscess cavity is eventually epithelialized, and thus a urethral diverticulum is formed. Very rarely, they are congenital or traumatic following urethroscopy or urethrotomy. Open surgical procedures such as anterior colporrhaphy or bladder neck suspension surgery may damage the periurethral fascia and create a traction diverticulum.
KeywordsUrethral diverticula Diagnosis Excision of urethral diverticula
Excision of urethral diverticula. An inverted U incision is made in the anterior vaginal wall. A flap is dissected free from the periurethral fascia with care not to enter the diverticula. A transverse incision is made on the periurethral fascia, and two flaps (one superior and one inferior) are created to expose the wall of the diverticula and sphincteric unit. The wall of the diverticula is carefully excised from the urethra. The communication of the diverticula to the urethra is closed in multiple layers. Interrupted figure-of-eight absorbable sutures are applied posterior to the urethra and to the endopelvic fascia to seal the periurethral space and prevent any dead space. The periurethral fascia is closed in transverse fashion with multiple figure-of-eight sutures. The vaginal wall flap is advanced distally to cover the area of the reconstruction. (MP4 251875 kb)