Female urethral diverticulum (FUD) remains a diagnostic and therapeutic challenge due to its variable clinical presentation, ranging from asymptomatic cases to complex symptomatic forms. We hypothesize that accurate diagnosis, supported by contemporary imaging modalities such as high-resolution magnetic resonance imaging (MRI), combined with a tailored surgical approach, can lead to significant improvements in both functional and sexual outcomes, even in anatomically complex or previously untreated cases..(1,2,3).Furthermore, we suggest that selected asymptomatic patients may be safely managed conservatively, provided that structured clinical follow-up is ensured. This study aims to illustrate the full clinical spectrum of FUD and evaluate the outcomes of our diagnostic and therapeutic strategies based on real-life clinical experience.

This retrospective study included female patients diagnosed with urethral diverticulum in our urology department from 2007 to 2021. Preoperative assessment involved detailed medical history, physical examination, cystoscopy, voiding cystourethrogram (VCUG), transvaginal ultrasonography, and pelvic MRI. Surgical candidates underwent complete diverticulectomy with multilayered urethral reconstruction. Postoperative follow-up was conducted at 3, 6, and 12 months, and then annually. A validated sexuality questionnaire was administered to both the patient and her partner before and after treatment to assess sexual outcomes

Fifteen patients were diagnosed with FUD. Twelve underwent surgical treatment, while three asymptomatic cases were managed conservatively. MRI was instrumental in diagnosing and characterizing diverticula, particularly in multiloculated and horseshoe-shaped presentations. Surgical outcomes were excellent, with all patients reporting significant symptom relief and no major perioperative complications. Ten out of twelve surgical patients resumed sexual activity with improved satisfaction, as did their partners. No recurrences or malignant transformations were observed over a follow-up period averaging 3.4 years. Conservatively managed patients remained asymptomatic during a mean follow-up of 2.1 years.

The use of MRI significantly contributed to both diagnostic precision and surgical planning, confirming its role as the imaging modality of choice. Surgical treatment was safe and effective, even in complex anatomical cases. The marked improvement in sexual function and quality of life among patients and their partners suggests a broader psychosocial benefit of treatment. Conservative management, though limited to a small subset, appears to be a valid short-term option in asymptomatic cases, warranting continued monitoring.

This study underscores the critical role of MRI in diagnosing and managing FUD and supports surgical intervention as the preferred approach in symptomatic or anatomically complex cases. Conservative management may be considered for select asymptomatic patients with close follow-up. Overall, a patient-centered, anatomy-guided strategy yields excellent clinical and functional results.

Stancik I, et al. Advances in MRI diagnostics for female urethral diverticula. Int Urogynecol J. 2022;33(5):1121–1129.
Yamamoto T, et al. Multiplanar MRI evaluation of female urethral diverticulum: correlation with surgical findings. Eur J Radiol. 2023;164:110775.
Jensen JL, et al. Asymptomatic female urethral diverticulum: natural history and management outcomes. Urology. 2021;157:120–126.