Urethral bulking for stress urinary incontinence: a first procedure or an option after a sling?

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Leaking urine when you cough, laugh, exercise or lift something is called stress urinary incontinence (SUI). It differs from urgency incontinence, when a sudden need to pass urine leads to leakage. Some women have both. Identifying which symptom is most troublesome matters because an injection aimed at SUI will not reliably treat urgency.

Urethral bulking involves placing small deposits of material into the wall of the urethra, usually through a fine instrument passed into the urethra. The deposits help the urethra close when pressure rises. You may hear this described as periurethral bulking, although many contemporary injections are delivered through the urethra into its surrounding wall. This is generally a day procedure under local anaesthesia or sedation/general anaesthesia, depending on the circumstances. It does not place a sling or mesh tape.

Could bulking be my first procedure?

Yes. After a trial of pelvic floor muscle training and discussion of other conservative measures, bulking can be chosen as a first procedure for appropriately assessed SUI. It may appeal to someone seeking a shorter procedure and recovery, or wishing to avoid a sling. It is also an option when a larger operation or anaesthetic carries additional risk. It is not usually the first treatment before conservative care. USANZ’s 2026 position statement lists bulking alongside autologous fascial slings, colposuspension and synthetic midurethral slings among the standard options that should be discussed. UGSA’s patient information stresses its lower success and frequent need for repeat treatment. [1–3]

Bulking, synthetic midurethral sling surgery, a sling made from the patient’s own fascia, and colposuspension have different benefits and risks. A donated-tissue (allograft) sling is distinct from a sling made from your own tissue (autograft) and from a synthetic mesh sling; the strength and duration of evidence for each are different. No single procedure is best for every woman. [1,4]

How effective and durable is it?

The realistic aim is often less leakage, rather than guaranteed dryness. Success figures change substantially depending on whether researchers count complete dryness, improvement, satisfaction, or avoidance of further treatment. UGSA’s patient leaflet quotes about 40–50% cure or improvement and reports that approximately 30% need a further injection within two years. These are broad counselling figures, not a prediction for an individual. [2]

Some women remain improved for years, but repeat injections or another operation may be needed. In a randomised comparison of polyacrylamide hydrogel injection and synthetic tension-free vaginal tape for primary SUI, the tape achieved better objective continence at one year (negative cough test 95.0% versus 66.4%). The five-year follow-up did not establish that injection was non-inferior to tape. The EAU similarly advises that bulking is generally less effective than slings or colposuspension for cure, and that repeat injection is likely. These findings do not mean everyone should have a tape: the value of a less invasive procedure and the acceptability of a possible repeat treatment are personal considerations. [4–6]

What if I still leak after a sling?

Bulking can be considered for persistent leakage soon after a sling or recurrent leakage after an initial period of improvement. It can sometimes reduce leakage without placing another sling. A 2022 systematic review of 11 studies after synthetic midurethral sling failure reported a pooled 75% cure-or-improvement rate, but also pooled failure and further-operation rates of 32% and 25%. The studies differed considerably in their patients, products, follow-up and definitions of success; the 75% figure should not be presented as a personal chance of cure. An American Urogynecologic Society clinical practice statement also recognises bulking as an option after a sling. [7,8]

After an allograft sling, the same clinical possibility exists, but the published post-sling bulking evidence is mainly about synthetic midurethral slings. We should not simply transfer those success figures to donated-tissue slings. The precise graft, previous surgery and examination findings should guide an individual discussion.

An injection should not be used to mask a sling complication. Before offering more treatment, I would review the original operation, check urine and bladder emptying, examine for prolapse, scarring and vaginal exposure, and assess whether leakage occurs with coughing or with urgency. Cystoscopy, a bladder diary, pad testing or urodynamics may be appropriate, especially after previous surgery, mixed symptoms, pain, blood in the urine or difficulty emptying. A tape or graft causing obstruction, exposure, erosion, infection or pain may require its own assessment and treatment. [1,3,7]

Is it safe? What are the side effects?

Most reported problems are short lived, but no injection is risk free. Possible effects include:

  • burning when passing urine and a little blood in the urine;
  • urinary tract infection;
  • temporary difficulty emptying the bladder, occasionally requiring short-term catheterisation;
  • new or persisting urgency symptoms; and
  • incomplete benefit, recurrence or the need for another injection or operation.

Less commonly, there may be persistent pain, a collection or infection at the injection site, or a reaction or complication related to the particular material. Risks also depend on anaesthesia, previous surgery and the chosen product. Emptying should be checked before discharge. Seek prompt assessment if you cannot pass urine, develop fever, worsening pain or heavy bleeding. [2,4,8]

Choosing a treatment

The first step is to confirm the type and severity of leakage and clarify your goals: complete dryness, meaningful improvement, shorter recovery, avoiding mesh, or avoiding the likelihood of repeat treatment. Pelvic floor therapy remains an initial option. When a procedure is appropriate, we can compare bulking with sling and colposuspension procedures using your examination findings, health history and preferences. If you have already had a sling, the reason for the continuing leakage deserves a fresh assessment before choosing another procedure.

This page is general education, not a recommendation for a particular product or a promise of a result. Treatment, including its material, risks, costs and alternatives, should be discussed during an individual consultation.

References

  1. Urological Society of Australia and New Zealand (USANZ). Surgical Treatment of Stress Urinary Incontinence: Position Statement Pol 054, version 2.0. Approved 9 May 2026.
  2. Urogynaecological Society of Australasia (UGSA). Urethral Bulking: Patient Information.
  3. UGSA. Stress Urinary Incontinence: Patient Resources.
  4. European Association of Urology. Guidelines on Non-neurogenic Female Lower Urinary Tract Symptoms: Disease Management, section 4.2.4.c.2.c.
  5. Itkonen Freitas A-M, et al. Tension-free vaginal tape surgery versus polyacrylamide hydrogel injection for primary stress urinary incontinence: a randomised clinical trial. Journal of Urology. 2020.
  6. Itkonen Freitas A-M, et al. Tension-free vaginal tape versus polyacrylamide hydrogel injection for stress urinary incontinence: five-year follow-up. NEJM Evidence. 2025.
  7. Braga A, et al. Urethral bulking agents for the treatment of recurrent stress urinary incontinence: a systematic review and meta-analysis. Maturitas. 2022. doi:10.1016/j.maturitas.2022.05.007.
  8. American Urogynecologic Society. Urethral Bulking: Clinical Practice Statement. Urogynecology. 2024. doi:10.1097/SPV.0000000000001548.

Information Sheet: Urethral Cancer

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Urethral Caruncle: A Small Lump That Can Cause Big Concern

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Finding a red or fleshy lump around the opening of the urethra can understandably be alarming. Fortunately, one of the most common causes, particularly in women after menopause, is a urethral caruncle.

A urethral caruncle is usually benign (non-cancerous) and may cause no problems at all. However, because several other conditions can look similar, a new, enlarging, bleeding or unusual urethral lesion deserves proper assessment.

What is a urethral caruncle?

A urethral caruncle is a small, fleshy growth arising from the lining of the urethral opening, or urethral meatus.

It typically appears as a soft red, pink or sometimes darker-red polypoid lesion at the edge of the urethral opening. It most commonly arises from the posterior or lower margin of the urethral meatus.

Caruncles occur predominantly in postmenopausal women, although they can occasionally occur in younger women.

Importantly, a urethral caruncle is not considered a precancerous condition. Its significance lies mainly in the symptoms it can produce and the fact that other urethral conditions can occasionally imitate its appearance.

What causes a urethral caruncle?

The exact cause is not completely understood, but several factors are thought to contribute.

Reduced oestrogen after menopause

This is probably the most important association.

After menopause, falling oestrogen levels cause thinning and reduced elasticity of the tissues surrounding the vagina and urethra. This is part of what is now commonly called genitourinary syndrome of menopause (GSM).

The urethral lining may become more fragile and susceptible to irritation, inflammation and prolapse.

Chronic inflammation and irritation

Repeated local irritation may contribute to inflammation around the urethral opening and subsequent formation of a caruncle.

Urethral mucosal prolapse

A caruncle may represent a localised form of prolapse of the urethral lining. This helps explain why the lesion usually occurs at the edge of the urethral opening.

What does a urethral caruncle look like?

A typical caruncle is:

  • Small and fleshy
  • Red or pink
  • Soft
  • Usually located along the lower edge of the urethral opening
  • Occasionally friable, meaning that it bleeds easily when touched
  • Sometimes tender or inflamed

They vary considerably in size. Some are barely noticeable, while larger lesions may protrude sufficiently to be felt or seen by the patient.

Although the appearance may be quite characteristic, appearance alone should not always be relied upon when a lesion is atypical.

What symptoms can it cause?

Many urethral caruncles are discovered incidentally during a pelvic examination and cause absolutely no symptoms.

When symptoms do occur, they may include:

Bleeding

The surface of a caruncle can be delicate and vascular. Patients may notice:

  • Spotting on underwear
  • Blood after wiping
  • Bleeding after intercourse
  • Blood noticed after passing urine

One important distinction is determining whether the blood is actually coming from the urethral lesion or whether there is true blood within the urine (haematuria).

Persistent haematuria may require additional investigation.

Pain or tenderness

An inflamed caruncle can become uncomfortable, particularly with wiping, intercourse or local pressure.

Burning when passing urine

Some patients experience dysuria or a stinging sensation as urine passes across the inflamed tissue.

A visible or palpable lump

Some women first become aware of the condition because they see or feel a small lump at the urethral opening.

Urinary symptoms

Large caruncles only rarely interfere significantly with urinary flow. If there is difficulty passing urine, a weak stream or urinary retention, other causes should also be considered.

How is a urethral caruncle diagnosed?

Diagnosis usually begins with a careful examination of the urethral opening and surrounding genital tissues.

A typical small caruncle in a postmenopausal woman often has a characteristic appearance.

Your doctor may also assess for associated vaginal and urethral atrophy and ask about urinary symptoms, recurrent urinary infections, bleeding and haematuria.

Depending on the circumstances, investigations may include:

  • Urinalysis
  • Urine culture if infection is suspected
  • Assessment for haematuria
  • Cystoscopy if there are unexplained urinary symptoms or blood in the urine
  • Biopsy or removal of the lesion when its appearance is atypical

Does a urethral caruncle need treatment?

Not necessarily.

A small, typical caruncle that causes no symptoms may simply be observed.

Treatment is generally considered when the lesion causes bleeding, pain, irritation or bothersome urinary symptoms, or when there is uncertainty about the diagnosis.

1. Observation

If the lesion is small, has a typical appearance and causes no symptoms, reassurance and observation may be all that is required.

This avoids treating something that is essentially harmless.

2. Topical vaginal oestrogen

In postmenopausal women, topical oestrogen therapy is frequently used, particularly when there are accompanying features of genitourinary syndrome of menopause.

Oestrogen can improve the quality and thickness of the tissues around the urethra and vagina and may allow a small caruncle to shrink considerably or resolve.

Treatment usually requires several weeks rather than several days.

The suitability of vaginal oestrogen should be discussed with your doctor, particularly if you have a history of an oestrogen-sensitive malignancy or another reason to avoid hormonal therapy.

3. Anti-inflammatory and supportive treatment

Where local inflammation is prominent, conservative measures may occasionally include:

  • Avoidance of irritating soaps and products
  • Treatment of associated infection if present
  • Appropriate topical therapy
  • Simple analgesia when required

These treatments may improve symptoms but do not necessarily remove the lesion itself.

When is surgery required?

Surgical removal may be recommended when the caruncle is:

  • Persistently painful
  • Repeatedly bleeding
  • Large or bothersome
  • Not responding to conservative treatment
  • Increasing in size
  • Firm, irregular, ulcerated or otherwise atypical
  • Associated with uncertainty about the diagnosis

Surgery usually involves excision of the lesion at its base, often as a relatively minor procedure.

The removed tissue can then be sent to a pathologist for examination under the microscope.

Possible complications are uncommon but can include bleeding, infection, discomfort, recurrence and, rarely, scarring or narrowing of the urethral opening.

Can a urethral caruncle be cancerous?

A true urethral caruncle is benign.

The more important question is whether a lesion that looks like a caruncle could occasionally be something else.

Several conditions may resemble a caruncle, including:

  • Urethral mucosal prolapse
  • Urethral polyps
  • Periurethral cysts
  • Urethral diverticulum
  • Genital warts
  • Inflammatory lesions
  • Melanoma
  • Urethral carcinoma
  • Other uncommon benign or malignant tumours

Cancer masquerading as an apparently innocent urethral lesion is uncommon, but this is precisely why an atypical lesion should not simply be labelled a caruncle and forgotten.

When should a biopsy be considered?

Biopsy or complete excision is particularly worth considering when a lesion is:

  • Irregular or unusually firm
  • Ulcerated
  • Pigmented
  • Rapidly enlarging
  • Persistently bleeding
  • Unusually large
  • Not responding as expected to conservative treatment
  • Associated with enlarged groin lymph nodes
  • Clinically inconsistent with a typical caruncle

In medicine, sometimes the smallest lump deserves a second look rather than a dramatic name.

Urethral caruncle versus urethral prolapse

These conditions can look similar but are not quite the same.

A urethral caruncle generally involves only a portion of the circumference of the urethral opening, most commonly its posterior margin.

A urethral prolapse usually involves the entire circumference of the urethral lining, creating a circular or doughnut-shaped ring of tissue surrounding the opening.

The distinction can influence management.

What about blood in the urine?

This is particularly important.

A caruncle may bleed externally and make it appear that blood has come from the urine. However, visible haematuria should not automatically be attributed to a urethral caruncle.

Depending on age, symptoms and individual risk factors, haematuria may require investigation of the bladder, kidneys and urinary tract.

The presence of a convenient little red lump should therefore not distract from investigating genuine haematuria appropriately.

Will a urethral caruncle come back?

Recurrence after treatment is possible, particularly if the underlying postmenopausal tissue changes persist.

Treatment of associated genitourinary syndrome of menopause may therefore remain useful even after the immediate caruncle has improved or been removed.

When should you see a urologist?

Consider seeking medical assessment if you notice:

  • A new lump around the urethral opening
  • Persistent urethral pain
  • Recurrent bleeding
  • Blood in the urine
  • A lesion that is enlarging
  • Difficulty passing urine
  • Recurrent urinary infections
  • A lesion that does not improve with treatment

Most urethral caruncles turn out to be harmless, but examination provides reassurance and ensures that less common conditions are not overlooked.

The Bottom Line

A urethral caruncle is a common benign lesion of the urethral opening, seen particularly in postmenopausal women.

Many require no treatment at all. When symptoms occur, topical vaginal oestrogen and conservative measures are often appropriate first-line options. Persistent, troublesome or atypical lesions may require surgical excision and pathological examination.

The most important message is simple: a typical urethral caruncle is usually nothing to fear, but an unusual urethral lesion deserves proper assessment rather than assumption.

Patient information disclaimer

This information is intended for general education and should not replace individual medical advice. A urethral or vulval lump, unexplained bleeding or blood in the urine should be assessed by an appropriately qualified healthcare professional.

Living with an indwelling urethral catheter

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An indwelling urethral catheter is a soft tube passed through the urethra into the bladder. A small balloon holds it in place and urine drains into a bag. It may be needed for a few days after an operation or for longer when the bladder cannot empty safely. The reason for the catheter and a plan for review should be clear to the patient and the people helping with their care.[1, 2]

Why might a catheter be needed?

Common reasons include acute urinary retention, an obstruction to urine flow, temporary drainage after surgery, and selected cases of chronic retention when other options are unsuitable. In hospital, a catheter may be used to monitor urine output in a critically ill person or manage bleeding and clots. It can occasionally support comfort at the end of life. A urethral catheter is generally not the first response to urinary leakage alone.[1]

When practical, the team should discuss whether the catheter can be removed after a trial of void, whether intermittent self-catheterisation is possible, or whether a suprapubic catheter may be more suitable for longer-term drainage. The best choice depends on bladder function, dexterity, the underlying condition and the person’s wishes.[1, 3]

What might it feel like, and what can go wrong?

Some people notice discomfort or a sense of needing to pass urine after insertion. Bladder spasms can cause cramping or urine to leak around the tube. Leakage can also mean that the catheter is kinked or blocked, so it should be checked rather than simply treated as incontinence. Other possible problems include blood in the urine after insertion or a change, skin irritation, accidental pulling or displacement, blockage from debris or encrustation, and infection.[2, 3]

A long-term urethral catheter can also cause pressure or trauma at the urethral opening; persistent soreness or a change in its appearance deserves review. Bladder stones and repeated blockages are further reasons to reassess the drainage plan. The longer a catheter remains, the more opportunity there is for bacteria to colonise it, so it should stay in place only while needed.[3, 4]

How often should a long-term catheter be changed?

There is no single safe change interval for every catheter and every patient. The plan depends on the catheter material and manufacturer’s instructions, local nursing policy, comfort, drainage, and whether it repeatedly blocks or becomes encrusted. Some community protocols plan changes approximately every four to eight weeks, but an individual plan may differ. The interval should not exceed the relevant product’s recommended duration.[1, 3]

Changing a catheter more frequently just to prevent infection has not been shown to help. A catheter may instead need an earlier change if it is blocked, damaged, displaced, causing problems, or as part of managing a symptomatic infection. People with a history of difficult insertion, urethral injury or bleeding should have a specific plan for who can safely perform the change.[1, 3]

At each review, it is worth asking: Is the catheter still necessary? Could a trial without it or another drainage method be considered?[1]

Day-to-day care at home

Keep the drainage bag below bladder level, avoid kinks in the tubing, and secure the catheter so it does not pull. Wash your hands before and after handling the bag. Follow the nurse’s instructions for emptying it and for cleaning the area where the catheter enters the body. Ordinary hygiene is usually enough; do not disconnect the closed drainage system, flush the catheter or take preventive antibiotics unless your treating team has given a specific instruction.[3, 5]

Drink according to your usual health advice. If you have a fluid restriction for heart or kidney disease, follow that plan rather than trying to drink extra to “flush” the catheter. Ask your nurse which supplies to keep at home and whom to call after hours if drainage stops.[2]

Bacteria in urine: when are antibiotics needed?

With a catheter in place, bacteria commonly grow on the catheter surface. After a month, bacteriuria is found in nearly everyone with a long-term catheter. A positive urine culture without symptoms usually reflects colonisation, not an infection requiring antibiotics. Routine screening or treatment of asymptomatic bacteriuria is generally discouraged because antibiotics can cause side effects and encourage resistant bacteria. Exceptions include pregnancy and certain invasive urological procedures, where the treating team will advise on testing and treatment.[4, 6]

Seek clinical assessment for possible infection if you develop fever, rigors, new pelvic or flank pain, feel distinctly unwell, or have other new symptoms that could indicate infection. In a frail person, a new change in function or confusion warrants assessment of several possible causes rather than automatically assuming a UTI. Cloudy or strong-smelling urine, sediment, or a positive dipstick on its own does not usually justify antibiotics.[4, 6, 7]

When a symptomatic catheter-associated UTI is suspected, a clinician should assess you and arrange a properly collected urine specimen if indicated—not from the drainage bag. Treatment is chosen in light of symptoms, culture results, allergies and local guidance. If the catheter has been in place for more than two weeks and still needs to remain, changing it as part of treatment is commonly recommended. Routine antibiotics at every scheduled catheter change are not recommended.[7, 8]

When to get help promptly

Contact your nurse or doctor promptly if urine stops draining, the catheter falls out, you have significant pain or new bleeding, or urine is leaking around the catheter with little in the bag. Check for a kink or a full bag, but do not forcefully flush or reinsert a catheter yourself unless specifically trained and instructed. Seek urgent medical care if drainage has stopped and you have a painful or swollen lower abdomen, or if you have fever, shaking chills or feel seriously unwell.[2]

Catheter support in Bundaberg

Some people can have catheter assessment and planned changes at home through a community nursing service. Ozcare and BlueCare provide home nursing in the Bundaberg area; whether a nurse can provide catheter care for an individual depends on referral, staffing, clinical needs, service area and funding arrangements. Ask the provider directly about availability and costs before relying on a visit.[9, 10]

For my Bundaberg patients, Sandra Ilett, a continence nurse with Community Nurse Service, is another local contact for bladder and catheter-related care. Sandra and her colleague Carla Kerr have also seen patients at the nurse-led clinic at The Friendlies Medical Suites. Patients can discuss a suitable referral and whether a home visit or clinic appointment is available. Community Nurse Service: (07) 4126 2002.[11] This mention recognises local nursing support; it is not a claim that one service is preferable for every patient.

A written catheter plan should record the reason for drainage, catheter details, the planned review or change, who will provide care, and whom to call if problems arise. Community nurses, the GP and urology team can then coordinate care across visits.

This article provides general information. Follow your individual catheter plan and seek clinical advice for new symptoms or a catheter that is not draining.

References

  1. Queensland Health. Urinary catheter insertion or change: indications and review.
  2. Healthdirect Australia. Catheter problems.
  3. Queensland Spinal Cord Injuries Service. Indwelling catheters.
  4. US Centers for Disease Control and Prevention. Indwelling urinary catheter culture stewardship.
  5. US Centers for Disease Control and Prevention. CAUTI prevention: summary of recommendations.
  6. Infectious Diseases Society of America. Management of asymptomatic bacteriuria.
  7. Queensland Spinal Cord Injuries Service. Management of urinary tract infection.
  8. US Centers for Disease Control and Prevention. Catheter urine culture collection guidance.
  9. Ozcare Bundaberg: home nursing and service area.
  10. BlueCare: community nursing at home; Bundaberg community service listing.
  11. Dr Jo Schoeman. Nurse-led urology clinic in Bundaberg: Sandra Ilett and Carla Kerr.

Flexible Cystoscopy with Urethral Dilatation

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A diagnostic day procedure under local anesthetic, where a flexible cystoscope is placed in the bladder via the urethra

Why is it done?

To investigate:

  • Hematuria (blood in the urine)
  • Recurrent urinary tract infections
  • Space occupying lesions in the kidneys, ureters, bladder and urethra
  • Abnormal cells suggestive of urothelial carcinoma, on urine cytology
  • Possible urethral stricture

How is it done?

  • A cystoscopy is performed by placing a camera in the urethra with the help of a   lubricant jelly and saline
  • If a narrowing is found, a guidewire will be placed and urethra dilated
  • The bladder is then distended using the fluid
  • The inside of the bladder is viewed for pathology.
  • If any suspicious lesions are seen, a biopsy will be taken.
  • Urine would have been sent for cytology prior to the procedure, to rule out the existence of cancer.
  • Antibiotics may be given to prevent infection

 

What to expect after the procedure?

  • An indwelling catheter will be placed for 3 days
  • Bladder infection ranging from a burning sensation to, fever, to puss (rare)
  • Blood stained urine
  • Lower abdominal discomfort which will persist for a few days
  • NB! Each person is unique and for this reason symptoms vary.

 

What next?

  • This all depends on what is found during the procedure. All the options will be discussed in detail.
  • With the removal of stents, the ureters have been dilated and will regain function (peristalsis) as soon as the stents are out. Thus slight pain can be expected in the first 24-48hrs.
  • Urethral strictures with an IDC will require a trial of void 3 days later
  • There may be some blood in the urine. This can be remedied by drinking plenty of   fluids until it clears.

Urethral Dilatation

  • If you have a urethral stricture, a guidewire will be placed and the narrowing dilated
  • There may be some hemorrhaging and you may need a catheter for 3 days
  • This will be removed at the hospital in 3 days or alternatively arrange for your GP to remove.
  • I will review in 6 –8 weeks

 

Wes Flexible Cystoscopy and Urethral Dilatation IDC

Exision of Urethral Caruncle Prolapsed Urethral Mucosa

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Why is it done?

  • Prolapsed urethral mucosa causing pain and bleeding
  • Occurs from childhood to old age

 

How is it done?

  • This procedure is done under a spinal/general anesthetic, as decided by the anesthetist.
  • The legs will be elevated into the lithotomy position.
  • This procedure is done with cystoscopy.
  • Your bladder and urethra are inspected with cystoscopy
  • The prolapsed mucosa will then be excised at the external meatus.
  • Dissolvable sutures will be placed for hemostasis
  • A catheter will be placed until you are awake for some compression.
  • Prophylactic antibiotics will be given to prevent infection.

Complications

Side–effects

  • Any anesthetic has its risks, and the anesthetist will explain all such risks.
  • Complications: hemorrhaging, and urine retention
  • Patients’ catheter will be removed the next morning.
  • If you cannot urinate after 2-3 attempts, a catheter may be inserted to empty your bladder.
  • You may be required to keep the catheter for a few days if you have persistent bleeding or urinary retention.
  • NB! Each person is unique and for this reason, symptoms may vary!

 

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Wes Urethral Caruncle – Prolapse Excision

Copyright 2019 Dr Jo Schoeman

Excision of Urethral Diverticulum – Female

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Why is it done?

  • Usually, an infected peri-urethral gland blocks and becomes infected
  • Causes a bulge which interferes with urination
  • Can mimic a vaginal prolapse
  • Usually, an MRI of the urethra delineates this beautifully.

How is it done?

  • This procedure is done under a general anaesthetic, as decided by the anaesthetist.
  • The legs will be elevated into the lithotomy position.
  • This procedure is done both cystoscopically and with an incision over the urethra.
  • The urethra is evaluated. endoscopically and a catheter placed
  • The vaginal mucosa will then be incised over the urethrocele.
  • A Fogarty catheter will be placed inside the diverticulum and the balloon inflated to delineate the borders of the diverticulum.
  • The diverticulum will be dissected out with injuring adjacent structures.
  • The neck will be tied off at the level of the adjoining urethra.
  • Dissolvable vaginal closure sutures will be placed for hemostasis
  • A cystoscopy confirms no injury to the urethra.
  • A catheter will be placed until you are awake for some compression.
  • Prophylactic antibiotics will be given to prevent infection.

Complications

Side–effects

  • Any anaesthetic has its risks, and the anaesthetist will explain all such risks.
  • Complications: hemorrhaging, and urine retention
  • Patients’ catheter will be removed the next morning
  • If you cannot urinate after 2-3 attempts, a catheter may be inserted to empty your bladder.
  • You may suffer temporary incontinence
  • You may suffer permanent incontinence as advised by Jo, depending on the extent of the diverticulum. Make sure you have discussed this with Jo.

NB! Each person is unique and for this reason, symptoms may vary

 

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Wes Urethral Diverticulum Excision Female

Copyright 2019 Dr Jo Schoeman

Excision of Urethral Diverticulum – Male

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Why is it done?

  • Usually, an infected peri-urethral gland blocks and becomes infected, UTI symptoms
  • Causes a bulge which interferes with urination
  • Can mimic prostate enlargement LUTS
  • Dribbling after urination
  • Usually, a retrograde urethragram the urethra delineates this beautifully.

How is it done?

  • This procedure is done under a general anesthetic, as decided by the anesthetist.
  • The legs will be elevated into the lithotomy position.
  • This procedure is done both cystoscopically and with an incision over the urethra (Bulbous Spongiosum or Perineum)
  • The urethra is evaluated endoscopically and a catheter placed
  • If it is a small urethral diverticulum, it can be opened into the urethra endoscopically
  • If it has a narrow neck, then an external approach:
  • The penis or perineum will then be incised over the urethrocele.
  • A Fogarty catheter will be placed inside the diverticulum and the balloon inflated to delineate the borders of the diverticulum.
  • The diverticulum will be dissected out with injuring adjacent structures.
  • The neck will be tied off at the level of the adjoining urethra.
  • Dissolvable closure sutures will be placed for hemostasis
  • A cystoscopy confirms no injury to the urethra.
  • A catheter will be placed until you are awake for some compression.
  • Prophylactic antibiotics will be given to prevent infection.

Complications

Side–effects

  • Any anesthetic has its risks, and the anesthetist will explain all such risks.
  • Complications: hemorrhaging, and urine retention
  • Catheter will be left in for 10 days
  • Trial without catheter in day surgery
  • If you cannot urinate after 2-3 attempts, a catheter may be inserted to empty your bladder.
  • You may suffer temporary incontinence
  • You may suffer permanent incontinence as advised by Jo, depending on the location of the diverticulum. Make sure you have discussed this with Jo before the surgery.
  • NB! Each person is unique and for this reason, symptoms may vary!

 

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Wes Urethral Diverticulum Excision Male

Copyright 2019 Dr Jo Schoeman