Surgical Techniques for Female Urethral Diverticulectomy: A Systematic Review and Educational Video Presentation

Female urethral diverticulum (UD) is an uncommon and often underdiagnosed condition. MRI has become the diagnostic standard, and transvaginal urethral diverticulectomy is the most widely accepted definitive treatment. However, technical variations persist across centers. The objective was to synthesize contemporary evidence on the surgical technique for female urethral diverticulectomy and summarize outcomes and complications, with an accompanying educational video highlighting key operative steps.

We performed a qualitative systematic review of peer-reviewed studies focused on female UD surgery, prioritizing series describing operative steps, perioperative management, and outcomes. Reporting is aligned to Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidance.

Across contemporary reviews and clinical series, common principles include precise anterior vaginal wall exposure; circumferential mobilization of the diverticular sac in the avascular periurethral plane; complete excision of the epithelialized sac; watertight urethral closure; and multilayer, non-overlapping repair of periurethral tissues with consideration of Martius labial fat pad interposition in complex or recurrent disease. Reported success (symptom resolution or no radiographic recurrence) is typically 83-97%, with reoperation rates 2-13%. De novo stress urinary incontinence occurs in ~ 2-33% and can be managed conservatively or with staged autologous pubovaginal sling. Distal marsupialization is an option only for selected distal lesions.

Transvaginal diverticulectomy yields a high cure rate with a low serious complication risk when key reconstructive principles are followed. We propose a standardized stepwise technique and checklist, and provide an educational video to assist adoption and training.