PATIENT INFORMATION FOR URETHRAL DIVERTICULECTOMY
What is it?
An operation to remove a urethral diverticulum; a small pocket or outpouching of the urethra. These may be congenital or result from blocked or infected glands in the urethra. What are the symptoms of a urethral diverticulum? Urine can collect in these and cause dribbling urine leakage after voiding. They can be a source of recurrent urine infections or cause discomfort when passing urine or during intercourse. Pressure on the urethra can cause difficulty passing urine, a weak urinary stream, pain, pressure or spasms in the urethra, a frequent and urgent need to pass urine and even an inability to empty the bladder completely. Stones can form within them in about 1 in 10 patients but cancers are extremely rare.
What tests might be required?
A urine test for infection, a cystoscopy, fluoroscopic urodynamic studies USS. Sometimes a special X-ray study of the urethra is required. MRI scans are best as diagnosing these.
What does a diverticulectomy involve?
The diverticulum is removed via a vaginal incision. The hole where it communicates with the urethra is closed. If there is also stress incontinence sometimes a procedure may be performed at the same time to correct this or deferred as a second procedure later. Sometimes tissue from within the labia is used to support and protect the urethra. This is called a ‘Martius labial fat pad graft’.
Will it work and for how long?
Most women, (86%) are relieved of their presenting symptoms and 10-15% can recur, this is more likely with larger/non complex diverticulum.
How long does the operation take?
About two hours. It depends on its size and whether any other procedures are required.
What is the usual post-operative course?
A vaginal pack placed during surgery is removed the following day. If a Martius graft is performed there will be a small wound drain in the labia which is removed after 1-2 days.
There are also usually two catheters placed during surgery; one via the urethra and one through the lower part of the abdominal wall, (suprapubic). These remain in for 10-14 days to allow the repair of the urethra to heal. Most patients can manage to empty the catheter bag themselves and can go home 1-2 days after surgery. After 10-14 days patients are usually readmitted and the catheter in the urethra is removed. A contrast X-ray is performed to ensure the urethra has healed and if so the suprapubic catheter is also removed once you are passing urine well. If the urethra has not healed the catheter will need to stay in until it has healed.
Other instructions for when you go home.
It takes about 1 week to return to normal activity. It is usual following surgery to have some spotting, bleeding or discharge from the vagina. This usually stops by about 2-4 weeks.
When this has stopped and the vaginal wound has healed you can have sexual intercourse or use tampons or pessaries, as comfortable, by about 4 weeks. Following discharge paracetamol is usually all that is required for pain relief. You can take up to 2 paracetamol every 4 hours to 6 hours (maximum 8 per day).
What are the risks and complications?
- There is a small risk of failure to remove all the diverticulum.
- Overall risk of complications is about 15%.
- Overall risk for recurrence is about 15%.
- There is also about a 15% risk of developing urinary incontinence, stress/new urgency.
- The risk of bleeding is small and the risk of requiring a blood transfusion is very small
- There is a small risk of urine infection or infection in the wound.
- There is a small risk of damage to surrounding structures like the bladder and ureter which could require further surgery to repair.
- It is very uncommon for the urethra to heal with scarring, resulting in narrowing of the urethra, (stricture).
- Failure of the urethra to heal can result in a communication between the urethra and vagina (a fistula), causing urinary leakage from the vagina and requiring further surgery.
- Irritative bladder symptoms or urgency may persist, needing medication to control.
- Difficulty passing urine may require prolonged catheter use and further testing and surgery or other treatment.
- If a Martias labial fat pad is performed, uncommon problems reported following this include pain with intercourse, intermittent discomfort at the wound, numbness, or altered appearance of the labia.
It is often not possible to warn patients of every possible risk or potential complication with surgery especially if very rare. Yet it is important that you are aware of what risks are involved, especially the more common ones. This information is not meant to alarm you but allow you to make an informed consent to have surgery. It is very rare but unfortunately some patients can suffer complications and end up worse off as a result of their surgery.
There are also general medical risks of abdominal, cardiovascular (heart), and pulmonary (lung) illnesses associated with surgery. These include Deep Vein Thrombosis (blood clots in deep leg veins), Pulmonary Embolus (these clots dislodging and going to the lungs), pneumonia, Myocardial Infarction (heart attack) and Cerebro-Vascular Accident (stroke)
There is a small risk of death; less than 5 in 10,000.
You will be given a follow up appointment.
If you experience any of the following problems after discharge you should contact the rooms or seek other medical attention;
- Severe pain not controlled with pain killers
- Wound problems – infection or breakdown
- Inability to pass urine or a catheter if required
- Or any other significant trouble.
If at any stage in the future your symptoms return you should arrange a review visit.
Version: V3, July 2017