Urethral diverticula remain relatively uncommon with a prevalence of approximately 1-5% in the general population (1). There are several theories to explain the cause of these diverticula (2); from chronic inflammation of the periurethral glands to trauma via surgical procedures (such as previous tape procedures), physical injury, or child birth (3).

We present an interesting video presentation showing the technique of trans-vaginal excision of urethral diverticulum with partial excision of trans-obturator tape and Martius graft.

The procedure was recorded and the video edited to comply with ICS conference submission requirements. A specialised medical illustration consent was obtained from the patient for the use and publication of the recording. The music used in the video is part of the public domain and is credited at the end of the video.

Case presentation

We present a case of a 52 year old patient who was referred with the classical triad of symptoms associated with urethral diverticulum (i.e. dysuria, dyspareunia and constant dribbling). Patient had history of trans-obturator tape. MRI and pre-operative translabial and endovaginal ultrasound scan showed the urethral diverticulum with the transobturator tape seen at the distal part of the diverticulum. 

After counselling, patient requested excision of the diverticulum and partial excision of the of the trans-obturator tape. Case was discussed in multidisciplinary team meeting which supported the patient’s choice of surgery. 

We present a recording of the procedure: identification and mobilisation of the diverticulum and tape, partial excision of trans-obturator, excision of urethral diverticulum and urethral repair including the use of Martius graft (fat pad) for support.

Patient had uneventful recovery with no immediate post-operative complications and no persistent urethral defect seen on cystourethrography.

There is lack of evidence of direct correlation between mid-urethral synthetic tape and development of urethral diverticulum, and excision of the diverticulum may be complicated by the presence of tape. We present a surgical video of an interesting case of excision of urethral diverticulum with partial excision of trans-obturator tape.

Burrows LJ, Howden NL, Meyn L, Weber AM. Surgical procedures for urethral diverticula in women in the United States, 1979-1997. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(2):158-61.
Custer L, Jessop M, Zaslau S, Shapiro R. A Case of Urethral Diverticulum with Surgical Repair Using Cadaveric Pericardial Tissue. Case Rep Urol. 2018;2018:6183618.
Athanasopoulos A, McGuire EJ. Urethral diverticulum: a new complication associated with tension-free vaginal tape. Urol Int. 2008;81(4):480-2.