Marsupialization of a Suburethral Diverticulum by the Spence Operation

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Vagina and Urethra

Anterior Repair and Kelly Plication

Site Specific Posterior Repair

Sacrospinous Ligament Suspension of the Vagina

Vaginal Repair of Enterocele

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Excision of Transverse Vaginal Septum

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Incision and Drainage of Pelvic Abscess via the Vaginal Route

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Le Fort Operation

Vesicovaginal Fistula Repair

Transposition of Island Skin Flap for Repair of Vesicovaginal Fistula

McIndoe Vaginoplasty for Neovagina

Rectovaginal Fistula Repair

Reconstruction of the Urethra

Marsupialization of a Suburethral Diverticulum by the Spence Operation

Suburethral Diverticulum via the Double-Breasted Closure Technique

Urethrovaginal Fistula Repair via the Double-Breasted Closure Technique

Goebell-Stoeckel Fascia Lata Sling Operation for Urinary Incontinence

Transection of Goebell-Stoeckel Fascia Strap

Rectovaginal Fistula Repair via Musset-Poitout-Noble Perineotomy

Sigmoid Neovagina

Watkins Interposition Operation

Marsupialization of a Suburethral Diverticulum by the Spence Operation

Suburethral diverticulum in the distal one-third of the urethra can be treated by simple marsupialization of the diverticulum. In these cases, it is not necessary to perform all the steps of a classic diverticular repair as prescribed in Vagina and Urethra. Although traditional operations for diverticula in the distal one-third of the urethra have produced problems with stenosis, marsupialization provides relief without complications.

Physiologic Changes. The suburethral diverticulum is marsupialized, and the source of chronic infection and urethritis is eliminated. Although the urethra is shortened by the marsupialization process, it is extremely rare for patients to experience urinary incontinence.

Points of Caution. The surgeon must be sure to marsupialize the entire suburethral diverticulum. When patients have multiple diverticula at the site, each diverticulum must be opened during the operation and incorporated into the marsupialization.

Technique

Figure 1 is a sagittal view of a suburethral diverticulum. B, bladder.

Figure 2 is a perineal view of the same diverticulum.

With Metzenbaum scissors inserted into the urethra and the vagina, an incision is made through the posterior wall of the urethra down to the diverticulum and also through the anterior wall of the vagina down to and including the diverticulum.

The diverticulum and urethra are now open. A 4-0 synthetic absorbable suture is used to marsupialize the epithelium of the vaginal mucosa to the urethral mucosa down to the sac of the diverticulum. The sac of the diverticulum is sutured to the anterior vaginal mucosa.

The completed operation shows the posterior wall of the urethra and the entire sac of the suburethral diverticulum marsupialized to the anterior vaginal mucosa.

Figure 6 is a sagittal view of the completed procedure. Note that although the urethra has been shortened, there has been no alteration in the pressure relationships between the lumen of the urethra and the bladder; therefore, urinary continence is not affected by the surgical procedure.