Rooh Ul Muqim, Talat Naz.
Urethral diverticulum in female
J Coll Physicians Surg Pak Jan 2004;14(1):55-6.
Surgical C Unit, Khyber Teaching Hospital, Peshawar

A 50 years old multipara presented to our outpatient department with the complaints of post void dribbling of urine for 6 years and dysuria with pelvic pain for 6 months. She had menopause 13 years ago. She was referred by a gynaecologist with a suspicion of urethral diverticulum after a negative dye test for a vesicovaginal fistula, and presence of a periurethral cystic swelling on EUA. She had a history of anterior colporrhaphy 13 years back. Patient was examined and about 2 cm size tender periurethral cystic mass was felt. An intravenous urography and voiding cysto-urethrography was done which did not reveal a diverticulum. The patient could not afford MRI. Biochemical and hematological investigations revealed normal blood urea creatinine, electrolytic levels, blood sugar level with hemoglobin of 10.5g%, normal leucocyte counts and ESR of 45 mm. Cystourethrocopy, with simultaneous digital compression of anterior vaginal wall, revealed a posterior diverticulum in the distal urethra. Transvaginal diverticulectomy was performed at the same sitting. The diverticulum including its communication site with the urethra was completely excised. The urethral defect was closed vertically over a Foley`s catheter. Periurethral fascia was reapproximated transversely and vaginal wall was closed. An antibiotic-soaked pack was kept and a suprapubic and urethral catheters were placed for sterile drainage. Parenteral antibiotics were continued for 24 hours followed by oral antibiotics for 2 weeks. Vaginal pack was removed on the first postoperative day. Vaginal examination after 2 weeks revealed intact suture lines, and urethral catheter was removed. A voiding cystourethrogram was performed and no extravasation was seen. The suprapubic catheter was removed and the patient was discharged home with advice for follow-up. At 6 weeks follow-up patient was asymptomatic

Category: Case Reports
Keywords: Urethral Diverticulum. Transvaginal Diverticulectomy. Dysuria. Urethrovaginal Colporrhaphy. Urethra. Diverticulum.

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