V-82 Presentación: Vídeo

Circumferential Female Urethral Diverticulum - An Uncommon Cause of Acute Urinary Retention
Miguel Marques Monteiro; João Vital; Gonçalo Mendes; Bernardo Teixeira; Mariana Madanelo; Alexandra Rocha; Sofia Mesquita; Diogo Gil; Manuel Oliveira; Paulo Príncipe
Centro Hospitalar Universitário de Santo António/Uls Santo António

A female urethral diverticulum is an uncommon condition. Diverticulectomy is the most commonly reported treatment, with the transvaginal approach leading to a high success rate. Recurrence, urethral stricture, and urethral-vaginal fistula are the most feared postoperative complications that are important to be in awareness. Taking into account the rarity of the situation and the complications’ potential, sharing the surgical approach is crucial to ensure the likelihood of a satisfactory outcome. We reported a case of a forty-seven-year-old woman without past gynecological or obstetric history or previous pelvic surgery. She was referred to our service with a history of refractory acute urinary retention with the incapacity of trial without the catheter. She had a history of recurrent UTI, dysuria, and dyspareunia. Besides, she denied urinary incontinence, postvoid dribbling, or voiding LUTS. The physical exam revealed a tender cystic palpable mass on the anterior vaginal wall with an expression of clear fluid when “milked”. Urethrocistoscopy showed a single mid-urethral ostia on the ventral urethra and MRI reported a large circumferential periurethral cystic lesions eliciting low T1 and high T2 signal with 3.1x 21x19,7 cm in distal to mid-urethra with ostia in ventral mid-urethra. This result was compatible with an idiopathic symptomatic circumferential female urethral diverticula with single ostia. The patient began intermittent vesical catheterization and prophylactic antibiotic therapy. In January 2023, she was submitted to transvaginal urethral diverticulectomy without any intercurrences. She was discharged in the next day with the indication of sexual abstinence during six weeks. In two weeks, the vesical catheter was removed. No urinary complaints were reported. Pathology reveals cystic lesions with a focal lining of urothelium and chronic inflammatory infiltrate and fibrosis. No neoplastic structures were found. Free uroflowmetry at one month of follow-up was normal with no postvoid residual. In six months of follow-up, patients deny any urinary symptoms or de novo urinary incontinence. She resumes her sexual activity without any pain. In conclusion, female urethral diverticula is a rare condition but may be bothersome. Transvaginal urethral diverticulectomy is a described procedure with a high success rate, however, with a significant risk of postoperative complications.