Female Urology
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Urethral Diverticulum
A urethral diverticulum is a variable sized pocket or “outpouching” that forms next to the urethra. Because it most often connects to the urethra, it may repeatedly fill with urine during the act of urination leading to symptoms.
Symptoms
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Some diverticula do not have symptoms. The classic symptoms of a urethral diverticulum are post-void dribbling, dyspareunia (pain with intercourse), and dysuria (pain with urination). Symptoms, however, vary widely depending on the location and size of the diverticulum.
Causes
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The leading theory is repeated infections of the periurethral glands with subsequent infection evolving into urethral diverticula.
Diagnosis
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A pelvic MRI gives us the best information to diagnose and plan for repair of the diverticulum. Your evaluation will also include a pelvic exam and possibly, a cystoscopy.
Treatment
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The best option for treatment is to excise the diverticulum (urethral diverticulectomy).
A urethral diverticulectomy is a surgical procedure in which, via an incision in your vagina, we remove the urethral diverticulum. The goals of the surgery are to remove as much of the diverticulum as possible in order to improve your symptoms.
What are the risks?
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Cure rates are good, however, there are some risks that are associated with the procedure. The risks of the surgery include incomplete removal of the diverticulum, leakage of urine after the surgery (stress incontinence), fistula formation (an abnormal connection between the urethra and the vagina) and stricture (scar) formation in addition to the usual risks of surgery.
Vesicovaginal Fistula
A vesicovaginal fistula is an abnormal connection between the bladder and the vagina that allows urine to flow from the bladder into the vagina.
Symptoms
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The most common symptom of a vesicovaginal fistula is incontinence or leakage of urine. The leakage may range from mild to profound depending on the size and location of the urethra.
Causes
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The most common cases of a vesicovaginal fistula are prior pelvic surgery or radiation therapy.
Diagnosis
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A vesicovaginal fistula may require several tests for diagnosis. These involve a pelvic examination, likely cystoscopy as well as two possible dye tests. You will also have an X-ray test to be sure the kidneys are not also affected as some patients may have both a vesicovaginal fistula and a ureterovaginal fistula (connected between the kidney tube(s) and the bladder.
Treatment
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Treatment options depend on several things including your medical condition/history, the cause and the location of the stricture. Options for repair include a vaginal or an abdominal approach. The goal of either approach is to excise or close the fistula tract and put healthy tissue in between the bladder and vaginal to help prevent the fistula from recurring.
A vaginal vesicovaginal fistula repair is done through an incision in your vagina. It involves removing the entire fistula with the surrounding scar tissue and then closing the hole in several layers. The surgery takes approximately three hours and can be done under spinal or general anesthesia. There are no stitches or bandages that have to be removed. All the stitches will dissolve on their own.
We do need to have a catheter draining your bladder for 3 weeks following the repair to allow the urethra to heal. We usually use a foley catheter (a catheter placed via your urethra), but may sometimes opt to use a suprapubic tube (the catheter is placed in your bladder via your lower abdomen right above your pubic bone).