To explore a more reasonable classification method for the evaluation and surgical planning for the management of female urethral diverticulum (UD).

This retrospective study included 45 female patients who underwent urethral diverticular excision between January 2018 and December 2023. Patient details and magnetic resonance imaging (MRI) data were collected. The diverticula were classified as complex (cUD) if MRI demonstrated >75% circumferential involvement of the urethra on axial imaging. All other UD were classified as simple (sUD). We performed complete diverticulectomy for sUD and partial excision for cUD. The presenting symptoms, physical examination findings, radiologic studies, operative findings, and post-operative results were compared between the complex and simple cohorts.

The mean age was 45.1 years (range: 25-82 years). The cUD and sUD groups contained 25 (56%) and 20 (44%) patients, respectively. Patients with cUD were more likely to demonstrate voiding symptoms (76% vs 40%, P = .031) and post-voiding dribbling (52% vs 15%, P = .013) than patients with sUD. The largest vertical diameters in the cUD and sUD groups were 2.52 ± 0.89 and 1.89 ± 0.89 cm, respectively (P = .061). The post-operative outcomes were similar between the sUD and cUD groups. There was no significant difference in the incidence of post-operative complications between the two groups.

Classification based on the angle of the diverticulum encircling the urethra on MRI can be used for the evaluation and surgical planning of female UD. The selection of an appropriate surgical approach is safe and efficacious for treating female UD and may reduce surgery-associated difficulties and complications.