This is an IRB-approved collection of female benign urethral findings captured during surgical procedures at the University of Michigan over more than a decade. The purpose of this presentation is to show diagnostic findings of various benign female urethral disorders, and cases are grouped based on women's chief complaint. This woman presented with pelvic pain, dyspironia, and dribbling. She had a prior mid-urethral synthetic sling that had caused a pseudo-diverticulum, also known as a traction diverticulum. Note the large circulation or dilatation below the bladder neck, and its wide neck with its proximal end being an obstructing mid-urethral sling. Note the large circulation or dilatation marked with an arrow, and its wide neck with its proximal end being an obstructing mid-urethral sling. This next woman has a large urethral diverticulum. Note the mid-urethral prominence obstructing the bladder neck opening, and in this picture, the os of the urethral diverticulum. You can appreciate the main os of the urethral diverticulum, and a second one on the patient's left side as well. The MRI shows a circumferential diverticula, as illustrated in the coronal views, and only one ostea was well seen in this axial image. This is a patient who presented with stress incontinence type leakage that did not respond to a prior bone anchor pulvovaginal sling. Fluoroscopic urodynamics were performed, and only the lateral view shows a clear urodynamic stress incontinence with cough maneuvers, associated with a urethral filling defect tract suggesting a possible ectopic ureter. This was confirmed during sister urethroscopy which revealed an ectopic urethral orifice, just proximal to the sphincter. Only one urethral orifice was encountered in the bladder. This woman, who was six months post diverticulectomy, had persistent dribbling, stress incontinence, vaginal pulling, and was diagnosed with a urethrovaginal fistula. In this picture, you can appreciate the large defect. A primary urethroplasty repair, an ontologous rectus fascia pulvovaginal sling, and a Martius flap were performed, and she had resolution of her symptoms. Mid urethral synthetic perforation or erosion often presents with severe dysuria. In this image, there is a perforation affecting the proximal urethra. The next complex case illustrates a coaptide deposit from a prior injection, which is partially obstructing the proximal urethra. You can easily appreciate the bulking agent beads through the mucosa. The next video is one of a woman who had injectable agents, a sling, and then a bladder neck incision done for retention. Her coaptide is extruding through her mucosa, causing hematuria and pain. This woman, also with severe dysuria and a urinary tract infection, after prior mid urethral synthetic sling, has a calcification at the bladder neck, and also a stone adjacent to her right urethral orifice. After the calcula is removed, we can appreciate there is a synthetic material eroding at the trigon. This cyst to examine under anesthesia shows a urethra that appears normal without evidence of stricture or fibrotic disease. This young patient presented with history of lower urethral symptoms, chronic pain, and prior urethral dilation and dysfunctional voiding on fluoroscopic urodynamics. The cyst was performed to rule out stricture. Then, another young woman with obstructive lower urethral symptoms and fluoroscopic urodynamics confirming a primary bladder neck obstruction. Cystic urethroscopy revealed very tight and high bladder neck with mucosal foldings. These frondular mucosal folds are often confused with polyps and inappropriately resected. These are common and have no significance. There was no evidence of stricture. We proceeded with an incision of the very high bladder neck at 10 and 2 o'clock, and she had complete resolution of all her lower urinary tract symptoms with no stress urinary incontinence. This woman had a stricture disease at the level of the bladder neck with the tissue concerning for malignancy given its unusual appearance and firmness. We performed a transurethral resection of the bladder neck to obtain biopsies and to open the lumen. The final pathology was squamous metaplasia without evidence of malignancy. She ultimately needed a urethroplasty for her disease. This 56-year-old female presented with recurrent urethral stricture disease after undergoing four prior repair attempts. A 9-fringe flexible hysteroscope was utilized to navigate the urethra, which was affected by fibrotic disease, as you can see in the video. Her urethra was severely hypospatic from prior repairs, so a full thickness buccal mucosa was harvested and used for a ventral graft urethroplasty. A 26-fringe Bougie was easily passed through the lumen of the urethra, and a martius flap was used to cover the graft. Finally, the vaginal flap was advanced to close the incision and a foley catheter was placed. This woman had obstructive lower urinary tract symptoms after a Puvo vaginal sling, and performed self-clean intermittent catheterization for a temporary time. She was evaluated to address persistent urinary tract infection, and cystourethroscopy did not reveal any unexpected findings. The next patient also presented with obstructive symptoms, and cystoscopy revealed an indent at the level of the proximal urethra from the Puvo vaginal sling without any other abnormality. Fluoroscopic urodynamics is shown next, during voiding phase. Note the prominent but closed bladder neck at the time of voiding. This is a spina bifida patient with a prior history of a bladder augment and an artificial urinary sphincter explant after it eroded into her urethra. She has significant scar along her proximal urethra from the erosion, and had a lead pipe urethra distally. She can perform clean intermittent catheterization with ACUDE successfully, and had a Puvo vaginal sling to treat her stress urinary incontinence. This woman presented with incontinence and was found to have an incidental mucosal prolapse at the meatus, a cruncle. Although it's often asymptomatic, it can be excised when associated with bothersome symptoms. This other patient had irritative and obstructive urinary symptoms, and had a circumferential donut-shaped urethral prolapse that was resected. The next images show an inferior urethral prolapse in a woman who presented with dysuria, vaginal pain, and spotting. Her symptoms resolved after this was resected in the operating room. This spinal cord injury patient, who has been chronically managed with an indwelling Foley, presented to our clinic with leakage around her catheter. As you can see, the urethra was very wide, and bone was palpable at the 12 o'clock position, creating a severe urethral erosion that is not amenable to reconstruction, and ultimately underwent a urinary diversion. Thank you for your attention.

female urethral disorders

surgical procedures

University of Michigan

pelvic pain

diverticulectomy