To demonstrate a modified approach to the Spence-Duckett procedure for treatment of a distal urethral diverticulum. A urethral diverticulum is an outpouching of urethral mucosa occurring in 2-5% of the population.<sup>1Bodner-Adler B, Halpern K, Hanzal E Surgical management of urethral diverticula in women: a systematic review Int Urogynecol J 2016 ;  27 : 993-100110.1007/s00192-015-2862-y [cross-ref]

Cliquez ici pour aller à la section Références</sup> They are thought to commonly arise due to chronic inflammation or infection of the peri-urethral glands.<sup>2Raz S Excision of urethral diverticula  Atlas of Vaginal Reconstructive Surgery New York, NY: Springer (2015). 10.1007/978-1-4939-2941-2_4

Cliquez ici pour aller à la section Références,3Foley CL, Greenwell TJ, Gardiner RA Urethral diverticula in females BJU Int 2011 ;  108 (suppl 2) : 20-2310.1111/j.1464-410X.2011.10714.x [cross-ref]

Cliquez ici pour aller à la section Références</sup>

We present a 37-year-old female with vaginal bulge, dyspareunia, and dysuria. On examination, she had a 2-centimeter tender mass abutting the distal urethra. Imaging such as ultrasound or magnetic resonance imaging is critical to map the location of the diverticula along the urethra and extent of urethral involvement as it can inform surgical technique. Diverticula are typically located postero-laterally at the mid- or distal urethra; however, they can be found at any location along the urethra.<sup>2Raz S Excision of urethral diverticula  Atlas of Vaginal Reconstructive Surgery New York, NY: Springer (2015). 10.1007/978-1-4939-2941-2_4

Cliquez ici pour aller à la section Références,3Foley CL, Greenwell TJ, Gardiner RA Urethral diverticula in females BJU Int 2011 ;  108 (suppl 2) : 20-2310.1111/j.1464-410X.2011.10714.x [cross-ref]

Cliquez ici pour aller à la section Références</sup> Care must be taken to avoid disruption of the continence mechanism at the mid-urethra to prevent incontinence after surgery. Magnetic resonance imaging revealed a 1.7 × 1.7 × 1.8 centimeter unilocular cystic structure at the left posteromedial distal urethra consistent with a urethral diverticulum. The patient desired surgical management.

Spence and Duckett traditionally described insertion of one blade of the Metzenbaum scissors in the urethra with incision into the diverticulum and anterior vaginal wall followed by marsupialization.<sup>4Spence HM, Duckett JW Diverticulum of the female urethra: clinical aspects and presentation of a simple operative technique for cure J Urol 1970 ;  104 : 432-437

Cliquez ici pour aller à la section Références</sup> Given the small size of the diverticular ostium identified, we opted to make an incision using a scalpel from the ostium down the posterior aspect of the urethra and proximally to the anterior vaginal wall. We then excised the diverticular sac prior to marsupialization. At 6 weeks after surgery, she had full resolution of her symptoms without development of urinary incontinence. Pathologic examination is important because while rare, cancers can originate from urethral diverticula, with a prevalence of 6-9%.<sup>5Vaidya RV, Olson K, Wolter C, Khan A Characterization of urethral diverticula in women Female Pelvic Med Reconstr Surg 2022 ;  28 : 54-5610.1097/SPV.0000000000001060 [cross-ref]

Cliquez ici pour aller à la section Références</sup> Pathology was consistent with urethral diverticulum and negative for dysplasia.

While effective, the Spence-Duckett technique is described as a “generous meatotomy” with risks of urethral shortening. Our modified approach reduces these risks, resolves bothersome symptomatology, improves cosmesis, and minimizes risk of anatomic or functional urethral compromise.