Urethral diverticulectomy
Surgery through the vagina to remove a pocket (diverticulum) that has formed off the urethra and to rebuild the urethra in layers. You go home with a catheter, usually for about 2 weeks, while it heals.
Also called urethral diverticulum surgery, urethral diverticulum removal, urethral diverticulum excision, UD repair, transvaginal urethral diverticulectomy, pocket on the urethra, urethral pouch removal, lump in the front wall of the vagina
- Where
- Hospital or outpatient surgery center operating room
- Anesthesia
- General anesthesia or spinal anesthesia
- Time in the room
- About 1.5 to 3 hours
- Hospital stay
- Same day or one night
- Going home with
- A catheter in the urethra, sometimes also a tube through the lower belly, usually for about 2 weeks and sometimes up to 3
- Back to normal
- About 4 to 6 weeks
- Back to work
- About 1 to 2 weeks for desk work, 4 to 6 weeks for physical work
Overview
A urethral diverticulum is a small pocket that forms off the urethra (the tube that carries urine out) and bulges into the front wall of the vagina. It most likely starts when one of the tiny glands beside the urethra becomes blocked and infected, then breaks open into the urethra. Urine and sometimes pus collect in the pocket. It is found most often in women between their 30s and 60s.
Common symptoms include dribbling of urine after you finish, pain, painful sex, repeated urinary infections, and a tender lump in the front wall of the vagina. Because these symptoms overlap with many other problems, the diagnosis is often delayed. An MRI of the pelvis is the best test to show the pocket, its size and shape, and where it connects to the urethra.
In the operation, done through the vagina, the surgeon opens the vaginal wall, removes the entire pocket, closes the hole in the urethra, and closes the tissues over it in several separate layers so the repair heals without a leak. A catheter rests in the urethra while it heals.
If you also leak with coughing or sneezing, this may be treated at the same time, usually with a sling made from your own tissue rather than synthetic mesh, because mesh is generally avoided next to a fresh urethral repair.
The parts of your body involved
The female urethra is about 1.5 inches (4 cm) long and sits just above the front wall of the vagina. Small glands line it. A diverticulum forms when one of these glands blocks, becomes infected, and opens into the urethra, leaving a pocket with a narrow neck (the opening, called the ostium). Some pockets are simple; others wrap partly or fully around the urethra like a saddle or horseshoe. A layer of firm tissue (the periurethral fascia) lies between the urethra and the vaginal wall and is an important layer in the repair.
- Urethra
The short tube that carries urine out of the body. The pocket connects to it.
- Diverticulum
The pocket itself. It can hold urine, pus, and occasionally small stones.
- Ostium
The narrow opening between the pocket and the urethra. Closing it is the key part of the repair.
- Periurethral fascia
A firm layer of tissue between the urethra and the vagina. It is closed as a separate layer over the urethral repair.
- Front wall of the vagina
Where the pocket is felt as a lump. The surgeon works through it.
- Bladder neck and sphincter
The muscles that keep you dry. The surgeon protects them during the repair.
Why it’s done
Surgery is recommended when a diverticulum causes symptoms that affect your life. If it causes no symptoms, watching it can be reasonable. Your surgeon will consider the size, shape, and location of the pocket on MRI, and whether you also leak urine.
- Repeated infections
Urine trapped in the pocket can cause infection after infection.
- Pain and painful sex
A tender, swollen pocket can make sitting, walking, and sex painful.
- Dribbling after urinating
Urine that collects in the pocket leaks out when you stand up after urinating.
- Stones or abnormal tissue
Stones can form in the pocket. Very rarely, abnormal or cancerous tissue grows inside it. Removing the pocket lets it be checked under a microscope.
- A growing lump or blocked flow
A large pocket can press on the urethra and make urinating harder.
Other options
- Watching it
If you have no or mild symptoms, your doctor may suggest checking it over time. A pocket rarely goes away on its own and may slowly enlarge.
- Antibiotics for flare-ups
Infections can be treated as they happen, but they tend to return while the pocket is there.
- Draining the pocket
An infected pocket that has formed an abscess may be drained first. This is a temporary step, and the pocket usually still needs to be removed once the infection settles.
- Marsupialization
For pockets very close to the urethral opening, the pocket can be opened into the vagina instead of removed. It is simpler but suits only a few pockets.
- Opening the pocket from inside
In selected cases, a surgeon can cut open the neck of the pocket with a scope through the urethra. There is less long-term experience with this approach.
Getting ready
Tick items off as you go. Your checklist is saved on this device only.
Weeks before
The week before
The day before
The morning of surgery
In the operating room, step by step
Press play or pick a step. Each drawing shows what your surgeon is doing at that moment. Your team may do some steps differently.
1. Anesthesia and positioning
You go to sleep, or have a spinal anesthetic. You lie on your back with your legs in padded stirrups. The vagina and surrounding skin are cleaned and draped.
After the operation
Right afterward
- Vaginal packing
The gauze packing is usually removed a few hours later or the next morning.
- Pain control
Pain is usually moderate and controlled with pills.
- Bladder spasms
Cramping from the catheter is common. You may be given a medicine to calm the bladder.
- Catheter teaching
Nurses show you how to empty the bag, switch between a leg bag and a night bag, and keep the catheter secured.
- Going home
Most women go home the same day or the next morning.
At home
- Pain
Use acetaminophen and, if allowed, ibuprofen. Take any stronger medicine only as prescribed.
- The catheter
Keep it in place and draining, secured to your thigh. Never let anyone remove or change it without asking your surgeon. Some urine may leak around it during spasms, which is common.
- Vaginal spotting
Light bleeding and discharge are normal for a few weeks. Use pads, not tampons.
- Bowels
Take a stool softener and avoid straining.
- Showering
You can shower the next day. No baths, hot tubs, or swimming until your surgeon says it is safe, usually around 4 to 6 weeks.
- Activity and lifting
Walk every day. Avoid heavy lifting (more than about 10 to 15 pounds) and hard exercise for about 4 to 6 weeks.
- Driving
You can drive once you are off opioid pain medicine and can sit comfortably, often after about a week.
- Sex
Nothing in the vagina (no sex, tampons, or douching) for about 6 weeks, until your surgeon checks the healing.
- Catheter removal
At about 2 to 3 weeks, an X-ray with dye in the bladder checks that the repair has healed before the catheter comes out. If there is a small leak, the catheter stays longer, and most small leaks heal.
- Work
Many women return to desk work within 1 to 2 weeks, even with the catheter in.
Recovery timeline
- Day 0Surgery
You wake up with a catheter and vaginal packing.
- Day 1Home
Packing out. Home with the catheter.
- Week 1Settling
Soreness eases. Bladder spasms are common but improve.
- Weeks 2 to 3Catheter out
An X-ray confirms healing and the catheter is removed.
- Weeks 3 to 6Urinating normally again
Some frequency and urgency at first, which usually settle. Spotting stops.
- 6 weeksCheck-up
An exam checks healing. Most women are cleared for sex and full activity.
- 3 to 6 monthsReviewing symptoms
Your surgeon asks about infections, dribbling, pain, and leaking. Imaging is repeated only if symptoms return.
- Long termStaying alert
Most women stay well. Tell your doctor if old symptoms come back.
What it feels like
Many women have had symptoms for months or years before the diagnosis, and some have been told it was only infections or only pain. Getting a clear answer can be a relief. The hardest part of recovery for most women is living with the catheter for a couple of weeks.
Before surgery
Embarrassment about the symptoms, and worry about sex and leaking afterward.
What helpsWrite down your questions and ask them all. Your surgeon has heard them before.
Waking up
Pressure from the vaginal packing and a strong urge to urinate even with the catheter in.
What helpsThe urge comes from the catheter and the swelling. Medicine for bladder spasms can help.
Bladder spasms
Sudden cramps low in the belly, sometimes with urine leaking around the catheter.
What helpsTake the spasm medicine as prescribed, drink steadily, and avoid constipation.
Life with the catheter
Self-conscious about the leg bag and nervous about pulling on it.
What helpsLoose skirts or pants hide a leg bag well. Secure the tubing to your thigh and switch to a larger bag at night.
The day the catheter comes out
Nervous, then relieved. The first few urinations may sting and you may go often.
What helpsThis settles over days to a few weeks. Call if you cannot urinate or notice a constant leak from the vagina.
Getting back to intimacy
Anxiety about pain or about damaging the repair.
What helpsWait until you are cleared, use plenty of lubricant, and go slowly. Tell your surgeon if sex is painful.
If symptoms linger
Worry that the pocket is back.
What helpsSome pain or urgency takes months to fully settle. If it does not, your surgeon can repeat the imaging.
How well it works
Most women find their symptoms go away or improve a great deal once the pocket is removed and the area has healed. Success is judged by your symptoms and an exam. An MRI is repeated only if symptoms come back.
- Healing check
An X-ray with dye before the catheter is removed confirms the urethra is sealed.
- Symptom relief
Fewer or no infections, no dribbling, and less pain.
- Bladder control
Tell your surgeon about any new leaking with coughing or exercise, so it can be checked and treated.
- Tissue results
The removed pocket is examined under a microscope. The result is almost always benign (not cancer).
Risks
Every operation has risks. These are the ones people ask about most, with honest odds where good numbers exist. Your surgeon’s own results matter more than averages.
Common
Cramps and leaking around the catheter. They stop once it is out.
Burning, fever, or cloudy urine. Treated with antibiotics.
Normal for a few weeks as the stitches dissolve.
Less common
Leaking with coughing or exercise after surgery. It may improve over time or need treatment.
More likely with large or complex pockets, or after earlier surgery. Another repair may be needed.
Scar tissue can narrow the urethra and slow the stream. It may need stretching or another procedure.
Some women have lasting tenderness or pain with sex. Pelvic floor therapy can help.
Usually settle over weeks to months.
Rare
A leak from the urethra into the vagina, causing a constant leak of urine from the vagina. It needs a longer catheter time or another repair.
Rare, more likely with very large pockets near the bladder neck.
Uncommon.
Call your care team or go to the emergency room if
- Fever of 101°F (38.3°C) or higher, or shaking chills
- The catheter stops draining for more than 1 to 2 hours, or falls out (do not reinsert it; call right away)
- Heavy vaginal bleeding (soaking a pad every hour) or large clots
- A constant watery leak from the vagina, especially after the catheter is removed
- You cannot urinate after the catheter is removed
- Severe pain not helped by your medicine
- Foul-smelling vaginal discharge, or redness and swelling
- Leg swelling or pain, chest pain, or shortness of breath (call 911 for chest pain or trouble breathing)
Questions to ask your surgeon
- What did my MRI show about the size and shape of the pocket?
- Do you recommend removing it, or is watching it reasonable for me?
- Do I leak with coughing, and should that be treated at the same time?
- If I need a sling, what type would you use?
- Will you use a fat pad flap (Martius flap)?
- How long will the catheter stay in?
- How will you check that the repair has healed before removing the catheter?
- How often does a pocket come back after your repairs?
- How many of these operations do you do each year?
- When can I have sex again?
Words you may hear
- Urethral diverticulum
- A pocket that forms off the urethra and bulges into the front wall of the vagina.
- Ostium
- The opening between the pocket and the urethra.
- Periurethral fascia
- A firm layer of tissue between the urethra and the vagina.
- MRI
- A scan using magnets that shows soft tissues in detail. It is the best test for this condition.
- Cystoscopy
- Looking inside the urethra and bladder with a thin camera.
- Voiding cystourethrogram
- An X-ray of the bladder and urethra with dye, used to check for leaks.
- Martius flap
- A pad of fatty tissue from the outer lip of the vagina, moved under the skin to cushion and protect the repair.
- Autologous fascial sling
- A sling made from a strip of your own tough tissue (fascia) to support the bladder neck.
- Fistula
- An abnormal opening between two organs, here between the urethra and the vagina.
- Stricture
- A narrowing caused by scar tissue.
- Stress urinary incontinence
- Leaking with coughing, sneezing, or exercise.
- Marsupialization
- Opening a pocket and stitching its edges so it stays open and drains.
Common questions
How did I get this?
It most likely began with a blocked, infected gland next to the urethra that opened into it. It is not caused by anything you did.
Is it cancer?
Almost never. Very rarely, abnormal tissue grows in a pocket, which is one reason it is removed and examined.
Will it come back?
Most women do not have it come back. The risk is higher with large or complex pockets.
Will surgery make me leak?
Some women develop new leaking with coughing or exercise. Your surgeon checks for leaking beforehand and may treat it during the same operation.
Will sex feel different?
Most women find that sex is more comfortable once the tender pocket is gone. Some have tenderness while healing, and a few have lasting pain that can be treated.
Is a Skene gland cyst the same thing?
No. A Skene gland cyst sits beside the urethral opening and does not connect to the urethra. Removing it is usually a simpler operation.
Why can't mesh be used for a sling at the same time?
Synthetic mesh placed next to a fresh urethral repair has a higher risk of wearing into the urethra or becoming infected, so surgeons generally use your own tissue instead.
Sources this page draws on
- European Association of Urology, EAU Guidelines on Non-neurogenic Female LUTS (section on urethral diverticulum)
- American Urological Association / SUFU, Updates to Surgical Treatment of Female Stress Urinary Incontinence (SUI): AUA/SUFU Guideline (2023)
- Campbell-Walsh-Wein Urology, Campbell-Walsh-Wein Urology, 12th edition (chapter on urethral diverticula) (2020)
Written November 2026. This page explains what usually happens. It is not medical advice and does not replace a conversation with your own surgeon, whose plan for you comes first.