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Case Series

Hybrid Sling for the Treatment of Concomitant Female Urethral Complex Diverticula and Stress Urinary Incontinence

, , , & ORCID Icon
Pages 247-253 | Published online: 14 Jul 2020

Figures & data

Figure 1 Magnetic resonance images showing a large incisional hernia with the presence of bowel (A, arrows) and omentum (B, arrows).

Figure 1 Magnetic resonance images showing a large incisional hernia with the presence of bowel (A, arrows) and omentum (B, arrows).

Figure 2 Magnetic resonance image of the pelvis.

Notes: (A) Axial slice demonstrating a complex urethral diverticulum. The small arrow points to the diverticulum lumen. The broad arrow indicates to the urethra. (B) Axial slice of the caudal area of the urethral diverticulum.
Figure 2 Magnetic resonance image of the pelvis.

Figure 3 Image of the patient’s abdomen in the standing position demonstrates an incisional hernia projecting from the umbilical scar to the pubic symphysis.

Figure 3 Image of the patient’s abdomen in the standing position demonstrates an incisional hernia projecting from the umbilical scar to the pubic symphysis.

Figure 4 Transvaginal ultrasound axial view shows complex urethral diverticulum as hypoechoic region around urethra.

Figure 4 Transvaginal ultrasound axial view shows complex urethral diverticulum as hypoechoic region around urethra.

Figure 5 Voiding cystourethrogram shows a complex multilocular diverticulum filled with contrast agent at the level of the midurethra.

Notes: (A) Anteroposterior image; (B) oblique image.
Figure 5 Voiding cystourethrogram shows a complex multilocular diverticulum filled with contrast agent at the level of the midurethra.

Figure 6 Image of two 2-cm horizontal incisions (over the iliotibial band and 6 cm above the patella) with the fascia lata strip.

Figure 6 Image of two 2-cm horizontal incisions (over the iliotibial band and 6 cm above the patella) with the fascia lata strip.

Figure 7 Images demonstrating diverticulectomy.

Notes: (A) UD (urethral diverticulum) dissected (broad arrow) and vaginal wall opened (small arrow). (B) UD resected and Foley catheter (broad arrow) and vaginal wall (small arrow). (C) Closure in three layers (urethral mucosa, pubocervical fascia – broad arrow; and vagina – small arrow).
Figure 7 Images demonstrating diverticulectomy.

Figure 8 Final aspect of the procedure.

Notes: The synthetic extension of the sling establishes the correct allocation through the obturator fascia. Conversely, the autologous segment decreases the risk of extrusion or erosion.
Figure 8 Final aspect of the procedure.

Table 1 One-Year Post-Operative Assessment Voiding Function

Table 2 Literature Review of Concomitant SUI and Diverticulum Repair