Feasibility assessment of modified chest-knee position in female urethral diverticulectomy: a single-center experience

Abstract

Introduction: This single-center experience assesses the technical feasibility of a modified chest-knee position for transvaginal female urethral diverticulectomy. The approach was developed to address ergonomic challenges and intraoperative visualization limitations associated with conventional lithotomy positioning during pelvic floor reconstruction. Clinical presentation: Six female patients (mean age: 42.67 years, normal BMI) presented with symptomatic uncomplicated mid/distal urethral diverticula (mean maximum diameter: 3.68 cm), presenting with dysuria, recurrent urinary tract infections, and palpable vaginal masses. Transvaginal ultrasound (TVUS) was utilized as the primary diagnostic modality, with MRI employed for suspected complex cases (e.g., multiloculation or sphincteric involvement). Intervention and outcomes: All patients underwent diverticulectomy under general anesthesia using the modified chest-knee position, which optimized anterior vaginal wall exposure. A layered closure technique preserved 5–10% of the diverticular wall to reduce urethral trauma. Key outcomes included a mean operative duration of 67.5 ± 28.3 min and mean positioning setup time of 8–10 min. No major perioperative complications (urethrovaginal fistula, stress incontinence) occurred. During a mean follow-up of 28.67 months (range: 11–74), all patients maintained complete symptom resolution without sonographic evidence of recurrence. Conclusions: This experience demonstrates the technical feasibility and perioperative safety of the modified chest-knee position for mid/distal urethral diverticulectomy. While technically feasible in our cohort, the limited sample size precludes definitive conclusions regarding ergonomic advantages or clinical superiority; consequently, further validation studies are warranted to substantiate these findings.