PMC7368585_01
Magnetic resonance images showing a large incisional hernia with the presence of bowel (A, arrows) and omentum (B, arrows).
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F0001
In addition to obesity (body mass index of 38 kg/m2) and the presence of a large incisional hernia (Figure 1A and B), pelvic magnetic resonance imaging demonstrated CUD (Figure 2A and B).
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.
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F0002
In addition to obesity (body mass index of 38 kg/m2) and the presence of a large incisional hernia (Figure 1A and B), pelvic magnetic resonance imaging demonstrated CUD (Figure 2A and B).
PMC7368585_02
Image of the patient's abdomen in the standing position demonstrates an incisional hernia projecting from the umbilical scar to the pubic symphysis.
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F0003
Transvaginal ultrasound axial view shows complex urethral diverticulum as hypoechoic region around urethra.
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F0004
Voiding cystourethrogram shows a complex multilocular diverticulum filled with contrast agent at the level of the midurethra.. Notes: (A) Anteroposterior image; (B) oblique image.
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Image of two 2-cm horizontal incisions (over the iliotibial band and 6 cm above the patella) with the fascia lata strip.
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F0006
The two parallel incisions were then connected, and this end of the graft was sectioned (Figure 6).
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).
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F0007
The patients were re-prepared and draped in a lithotomy fashion, and diverticulectomy was performed with an ellipsoid vaginal incision (Figure 7A). The UD was grasped and dissected circumferentially down to the ostium (Figure 7B). The periurethral fascia were closed with 3/0 interrupted absorbable sutures perpendicular to the urethral closure (Figure 7C).
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.
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F0008
At the end of the procedure, the sling was manipulated so that its middle part (fascia) rested directly below the urethra, considering the chances of erosion with an SS (Figure 8).