Diagnosis and Management of a Calculous Female Urethral Diverticulum: A Case Report with a Review of the Literature

Background: Female urethral diverticulum (FUD) is a rare condition with an estimated prevalence of 1–6% in adult women. Intraluminal calculus formation is an uncommon but well-recognised complication, occurring in 1.5–10% of FUD cases, resulting from chronic urinary stasis within the diverticular sac.
Case Report: We report the case of a 43-year-old multiparous woman (G4P4) presenting with a two-year history of an anterior vaginal mass. Pelvic MRI confirmed an inter-urethrovaginal cystic lesion communicating with the urethra and containing a 15 × 11 mm hypointense calculus. The patient underwent transvaginal diverticulectomy with simultaneous stone extraction and a tension-free three-layer repair. The postoperative course was uneventful.
Conclusion: This case highlights the importance of considering FUD with calculus in any patient presenting with an anterior vaginal mass. Pelvic MRI is the gold-standard investigation. Transvaginal diverticulectomy with multilayer closure remains the surgical treatment of choice.