Managing Urethral Diverticulum During Pregnancy Utilizing Advanced Ultrasonographic Techniques: A Literature Review and Case Study.

Abstract

Urethral diverticulum (UD) during pregnancy is a rare clinical condition, with limited literature available to guide standardized management. Fewer than a dozen well-documented cases have been reported, but they reflect a wide range of clinical approaches from antenatal surgery to postpartum intervention. We report the case of a 36-year-old woman diagnosed at 34 weeks of gestation with a 5.5 cm urethral diverticulum, presenting with suprapubic pain, urinary dribbling, and green vaginal discharge. Conservative management was pursued due to obstetric concerns, including multiple uterine fibroids and risk of preterm labor. Advanced ultrasonographic techniques-biplane transvaginal imaging, transperineal ultrasound, and 3D surface rendering-enabled a detailed anatomical assessment of parameters including the lesion's size, shape, and relationship to the urethra, without resorting to invasive diagnostics. The diverticulum was found to cause 90° urethral angulation and had a C-shaped configuration, with a volume of 11.5 cm³. Following antibiotic treatment, the patient's symptoms improved, and she remained clinically stable. She was scheduled for vaginal delivery followed by postpartum diverticulectomy. This case illustrates the diagnostic value of high-resolution ultrasound in pregnancy and supports literature recommendations favoring conservative treatment and delayed surgery to reduce maternal and fetal risk. Vaginal delivery remains a viable option in select UD cases.