Information about your procedure from
The British Association of Urological Surgeons (BAUS)
This leaflet contains evidence-based information about your proposed
urological procedure. We have consulted specialist surgeons during its
preparation, so that it represents best practice in UK urology. You should
use it in addition to any advice already given to you.
To view the online version of this leaflet, type the text below into your web
browser:
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Key Points
• This procedure is intended to remove a diverticulum (outpouching)
from your urethra (waterpipe)
• You will need to have a bladder catheter (a tube through your
urethra) that stays in for several weeks
• Some patients develop problems with incontinence that may need
further treatment
• Some patients develop narrowing in the urethra due to scar tissue
• Some patients need to have further surgery if the diverticulum
comes back or if there are complications
What does this procedure involve?
A urethral diverticulum is a “pocket” or outpouching that forms next to
your urethra (waterpipe). Because it connects to the urethra, this
outpuching repeatedly fills with urine when you empty your bladder and
causes symptoms. This procedure removes the diverticulum through a cut
in your vagina.
What are the alternatives?
• No treatment – if your diverticulum causes no symptoms, sometimes
it can be left alone and not treated
• Opening the diverticulum into the vagina – the diverticulum can
be opened with a small incision into your vagina, and not removed;
this is not usually as good as removing it
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What happens on the day of the procedure?
You will be seen by the surgeon and the anaesthetist who will go through
the plans for your operation with you.
We may provide you with a pair of TED stockings to wear, and give you a
heparin injection to thin your blood. These help to prevent blood clots from
developing and passing into your lungs. Your medical team will decide
whether you need to continue these after you go home.
Details of the procedure
• we normally carry out the procedure under a general anaesthetic
with you asleep) or a spinal anaesthetic (where you are awake but
unable to feel anything below your waist)
• the surgeon will look inside your urethra and bladder using a
telescope (cystoscope)
• we make a small incision inside your vagina
• we separate the diverticulum from your urethra and remove it; this
leaves a small hole in your urethra which we repair using fine
dissolvable stitches
• we usually reinforce the repaired area by positioning some of your
body’s own tissue over your urethra; this might be some tissue from
under your vaginal skin or fat from your labia (the hair-bearing
vaginal lips)
© Tamsin Greenwell
• if tissue from the labial lips is used, you will have a small cut over
your labia. We sometimes leave a small drain in place; this is a small
plastic tube that comes out of the skin and helps any blood drain out;
it is usually removed a day or two after the operation
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• we use dissolvable stitches in your vaginal skin (and in your labia, if
needed) which disappear after two to three weeks
• we often place a small pack inside your vagina; this is usually
removed the next day
• you will have a catheter inside your bladder through your urethra;
this will stay in after you go home so that your urethra has had a
chance to heal. Your surgeon will tell you when it will be removed
• sometimes, we put another catheter into your bladder through your
abdomen (tummy) as well; this is called a suprapubic catheter
You may experience some bleeding from your vagina over the first few
days, but this usually stops quickly.
Your catheter needs to stay in for at least two weeks but you will be able to
go home with the catheter. When it is removed, you may get some
discomfort passing urine at first.
Are there any after-effects?
The possible after-effects and your risk of getting them are shown below.
Some are self-limiting or reversible, but others are not. We have not listed
very rare after-effects (occurring in less than 1 in 250 patients) individually.
The impact of these after-effects can vary a lot from patient to patient; you
should ask your surgeon’s advice about the risks and their impact on you as
an individual:
After-effect Risk
Mild vaginal bleeding (for the first two
Almost all
days), bruising or blood clot under your
patients
skin
Temporary pain in your incisions requiring
Almost all
simple painkillers such as aspirin,
patients
paracetamol or ibuprofen
Between 1 in 10 &
Stress incontinence (leakage of urine when
1 in 20 patients
you cough, sneeze or exercise)
(5 – 10%)
Between 1 in 20 &
Wound infection 1 in 50 patients
(2 – 5%)
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Between 1 in 20 &
Recurrence of the diverticulum (i.e. the
1 in 50 patients
problem comes back again)
(2 – 5%)
Between 1 in 20 &
Difficulty passing urine due to scarring &
1 in 50 patients (2
narrowing of your urethra
– 5%)
Between 1 in 50 &
Change in the shape or appearance of your
1 in 250 patients
labia (vaginal lips)
(less than 2%)
Severe bleeding requiring a further Between 1 in 50 &
procedure 1 in 250 patients
Fistula (a connection between the urethra Less than 1 in 50
and the vaginal skin with possible leakage patients (less
of urine) than 2%)
Anaesthetic or cardiovascular problems Between 1 in 50 &
possibly requiring intensive care (including 1 in 250 patients
chest infection, pulmonary embolus, stroke, (your anaesthetist
deep vein thrombosis, heart attack and can estimate your
death) individual risk)
What is my risk of a hospital-acquired infection?
Your risk of getting an infection in hospital is approximately 8 in 100 (8%);
this includes getting MRSA or a Clostridium difficile bowel infection. This
figure is higher if you are in a “high-risk” group of patients such as patients
who have had:
• long-term drainage tubes (e.g. catheters);
• bladder removal;
• long hospital stays; or
• multiple hospital admissions.
What can I expect when I get home?
• you will be given a copy of your discharge summary and a copy will
also be sent to your GP
• you will be discharged with a catheter in your bladder; we will show
you how to manage it at home and arrange for it to be removed at a
suitable time
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• you may get pain in your vagina for a few weeks afterwards; simple
painkillers usually help
• for the first four weeks, you should avoid any strenuous activity or
heavy lifting
• after four weeks, you may return to everyday activities; if you do a
very heavy job or partake in strenuous exercises such as running or
gym work, you should wait for longer and start gradually
• you will need at least three weeks off work; you may need longer if
you have a strenuous job (your surgical team will be able to advise
you about this)
• you should avoid sexual intercourse for six weeks after the procedure
General information about surgical procedures
Before your procedure
Please tell a member of the medical team if you have:
• an implanted foreign body (stent, joint replacement, pacemaker,
heart valve, blood vessel graft);
• a regular prescription for a blood thinning agent (warfarin, aspirin,
clopidogrel, rivaroxaban or dabigatran);
• a present or previous MRSA infection; or
• a high risk of variant-CJD (e.g. if you have had a corneal transplant, a
neurosurgical dural transplant or human growth hormone
treatment).
Questions you may wish to ask
If you wish to learn more about what will happen, you can find a list of
suggested questions called "Having An Operation" on the website of the
Royal College of Surgeons of England. You may also wish to ask your
surgeon for his/her personal results and experience with this procedure.
Before you go home
We will tell you how the procedure went and you should:
• make sure you understand what has been done;
• ask the surgeon if everything went as planned;
• let the staff know if you have any discomfort;
• ask what you can (and cannot) do at home;
• make sure you know what happens next; and
• ask when you can return to normal activities.
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We will give you advice about what to look out for when you get home.
Your surgeon or nurse will also give you details of who to contact, and how
to contact them, in the event of problems.
Smoking and surgery
Ideally, we would prefer you to stop smoking before any procedure.
Smoking can worsen some urological conditions and makes complications
more likely after surgery. For advice on stopping, you can:
• contact your GP;
• access your local NHS Smoking Help Online; or
• ring the free NHS Smoking Helpline on 0800 169 0 169.
Driving after surgery
It is your responsibility to make sure you are fit to drive after any surgical
procedure. You only need to contact the DVLA if your ability to drive is
likely to be affected for more than three months. If it is, you should check
with your insurance company before driving again. You should not drive
until you can move safely around the car and perform emergency braking
without any pain. If you experience any pain on braking, you should not
drive until it settles.
What should I do with this information?
Thank you for taking the trouble to read this information. Please let your
urologist (or specialist nurse) know if you would like to have a copy for
your own records. If you wish, the medical or nursing staff can also arrange
to file a copy in your hospital notes.
What sources have we used to prepare this leaflet?
This leaflet uses information from consensus panels and other evidence-
based sources including:
• the Department of Health (England);
• the Cochrane Collaboration; and
• the National Institute for Health and Care Excellence (NICE).
It also follows style guidelines from:
• the Royal National Institute for Blind People (RNIB);
• the Information Standard;
• the Patient Information Forum; and
• the Plain English Campaign.
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Due for review: April 2020 © British Association of Urological Surgeons (BAUS) Limited
Disclaimer
We have made every effort to give accurate information but there may still
be errors or omissions in this leaflet. BAUS cannot accept responsibility for
any loss from action taken (or not taken) as a result of this information.
PLEASE NOTE
The staff at BAUS are not medically trained, and are unable to answer
questions about the information provided in this leaflet. If you do have
any questions, you should contact your urologist, specialist nurse or GP.
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Due for review: April 2020 © British Association of Urological Surgeons (BAUS) Limited
