This study presents the surgery and outcome of a patient with giant urethral diverticulum causing urinary obstructive symptoms.

A 35-year-old patient was admitted with complaints of urinary tract infection that recurred for the past one year, difficulty in urinating and straining which progressed during this period. The patient’s examination and Pelvic MRI showed a giant cystic structure surrounding the urethra (Figure I). Surgery was planned for cyst excision. Technically, lateral fixations were placed on the labia majora in lithotomy position under general anesthesia. In urethroscopy, diverticulum opening was seen in the urethra at 7 o’clock and a guidewire was sent. The vagina was opened under the urethra with vaginal axial incision and the diverticulum was dissected from the vaginal wall (Figure II). The diverticulum was dissected from the lateral and anterior and the diverticulum opening was seen. Following diverticulum excision, the urethra was repaired primarily with 3-0 polyglactin. 18 Fr foley catheter was inserted. The vaginal wall was closed with 2-0 polyglactin suture.

The patient’s foley catheter was removed in the third operative week. The patient stated that her complaints had regressed. Maximum flow rate increased to 25 ml/sec from 15 ml/sec. No complications were seen in the preoperative and postoperative period.

Urethral diverticulum may cause urethral obstruction in women. Surgical excision and urethroplasty improve symptoms in these patients.