Felicity A. Reeves, Richard D. Inman, Christopher R. Chapple

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Presentation transcript:

Management of Symptomatic Urethral Diverticula in Women: A Single-centre Experience Felicity A. Reeves, Richard D. Inman, Christopher R. Chapple European Urology Volume 66, Issue 1, Pages 164-172 (July 2014) DOI: 10.1016/j.eururo.2014.02.041 Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 1 Postvoid sagittal magnetic resonance imaging of the pelvis showing a circumferential urethral diverticulum filling after the bladder has emptied. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 2 Progress of a urethral diverticulum with the potential complication of fistulating into the vagina. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 3 Vaginal and urethral access in the prone position. The ureteric catheters and urethral catheters are seen exiting from the external urethral meatus. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 4 Surgical technique demonstrating the prone position with Parkes anal retractor in place and stay sutures to raise a U-shaped vaginal flap to allow dissection onto the urethral diverticulum. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 5 Raised U-shaped vaginal flap in the prone position. Stay suture placed on the diverticulum awaiting excision. Urethral catheter and ureteric catheters seen exiting the urethral meatus. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 6 Anterior wall of the vagina with urethra open, post diverticular excision, ureteric and urethral catheters seen directly in the urethra. Stay sutures placed on lateral vaginal walls ready to facilitate urethral repair and vaginal closure. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 7 Photograph showing urethral and vaginal closure using figure-of-eight sutures. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 8 Incision into left labia majora as access to harvest a Martius graft. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 9 Harvesting of a right Martius graft on vascular pedicle to obliterate a large defect post diverticulum excision in the prone position. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions

Fig. 10 Outcomes for 89 patients post urethral diverticular repair displayed as a clean percentage. CISC=clean intermittent self-catherisation; SUI=stress urinary incontinence. European Urology 2014 66, 164-172DOI: (10.1016/j.eururo.2014.02.041) Copyright © 2014 European Association of Urology Terms and Conditions