Excision Of Diverticulum Research Articles

341. EXCISION OF EPIPHRENIC DIVERTICULUM WITH CARDIOMYOTOMY AND FUNDOPLICATION

Abstract Background Epiphrenic diverticulum, a type of pulsion diverticulum, is a rare esophageal diverticulum that occurs in up to 2% of the population. It is commonly located in the distal esophagus, 4 to 8 centimeters (cm) above the gastric cardia. Etiology includes raised intraluminal esophageal pressure and is often associated with an underlying esophageal motility disorder. Indications for surgical intervention depends on presence of symptomatic disease including worsening dysphagia, food retention, regurgitation and complications such as aspiration pneumonia. This video illustrates the surgical management of epiphrenic diverticulum and associated surgical outcomes. Methods 60-year-old male initially presented with symptoms of dysphagia, food regurgitation and reflux. Gastroscopy performed identified a large esophageal diverticulum, 3cm from cardioesophageal junction (CEJ) and barium swallow study as well as high resolution manometry verified normal esophageal motility. Biopsies did not show any dysplasia. Patient subsequently underwent laparoscopic excision of epiphrenic diverticulum, cardiomyotomy and anterior 180 degrees fundoplication. Intra-operatively, epiphrenic diverticulum was noted on right lateral aspect of esophagus with a 3cm wide neck, 3cm from CEJ. Diverticulum was resected using a linear stapler and cardiomyotomy was perfomed on the contralateral side along with a partial fundoplication. Results Patient had an uneventful post-operative recovery with no post-operative complications. Histology confirmed esophageal diverticulum with no dysplasia or malignancy seen. Water soluble contrast study performed on post-operative day 1 and 1 year later demonstrated smooth passage of contrast with no hold up. There was also complete resolution of presenting symptoms on follow-up reviews. Conclusion Epiphrenic diverticulum is a rare entity but may present with debilitating symptoms that can affect patient’s quality of life and function. Management of symptomatic patients involves resection of the diverticulum as well as a myotomy and fundoplication to address any underlying motility disorder. This case aims to illustrate the efficacy and positive surgical outcomes that can be achieved with this combined surgical approach. https://www.dropbox.com/scl/fi/v6ow104q16lgfjhdqajix/Diverticulum-excision-v6.mp4?rlkey=nlmta6y835myqzf2rdf9mqocm&dl=0

Analysis of Various Laparoscopic Pediatric Urology Surgeries: Five-Year Experience of a Single Institution.

Background In this study, we aim to report our single-center experience with laparoscopic pediatric urological surgeries. We aim to determine the feasibility of various urological and urogenital laparoscopic procedures and the tricks that increase surgical success. Methodology Data from 98 patients who underwent laparoscopic urological and/or urogenital procedures for diagnostic and therapeutic purposes in our clinic between June 2018 and February 2023 were retrospectively analyzed. All surgeries were performed by the same surgical team. Laparoscopic procedures included orchidopexy, gonadectomy, vaginoplasty, hysterectomy, pyeloplasty, nephrectomy/partial nephrectomy, ureteroneocystostomy, bladder diverticulum excision, renal cyst excision, proximal ureter stone removal, oophorectomy, ovarian detorsion, oophoropexy, and lymph node excision for diagnostic purposes. The surgical planning of the patients was based on the decisions of the pediatric nephrology, pediatric endocrinology, and pediatric oncology departments and the multidisciplinary council. Demographic characteristics of the patients, surgical indications, and intraoperative data, as well as postoperative pathological diagnoses and complications, were recorded. All patients underwent a transperitoneal approach. The duration of the operation was obtained from anesthesia records and defined as the time from the beginning of the surgical incision to the closure of the skin incision. Results Of the patients, 54 were males and 44 were females. The median age was 7.8 years. No complications other than grade 1 according to the Clavien-Dindo classification were observed in our patients. As different types of surgeries were analyzed, the mean operative duration was estimated. Conclusions The laparoscopic method should be performed by surgeons experienced in advanced surgeries in pediatric urology. It is critical to consider the difference in the size of pediatric patients in preparation for laparoscopic surgery to minimize technical and ergonomic problems. We believe that each surgery has its specific tricks and that these should be a part of laparoscopy training. Moreover, developing and sharing this information would be very useful for pediatric urologists.

Case Report: Urethral Diverticulum after Distal Hypospadias Repair: An Uncommon Complication.

Abstract* Introduction A urethral diverticulum can be defined as a pocket that forms from the lining of the urethra and protrudes into the surrounding tissue, a condition which causes voiding dysfunction and may result as a rare complication of hypospadias repair surgery. Case report We report the case of a 2-year-old child who presented to us in 2019 complaining of a thin forceful stream, ballooning of the ventral aspect of the penis while voiding, and post-void dribbling. He has a history of undergoing a tabularised incised plate urethroplasty for distal penile hypospadias at 18-months-old. Ultrasound showed increased post-void residual volume and cystourethroscopy confirmed a urethral diverticulum extending from the subcorona to the base of the penis. The patient underwent partial excision of diverticulum, urethroplasty, and meatoplasty. He was followed-up 3 months later with complete resolution of his symptoms and a normal urinary stream with no urethral ballooning or dribbling. Conclusion Urethral diverticulum may present as a complication post hypospadias repair. Although it is rare, we believe that it is important for the patient’s parents to understand the possibility and know of the signs and symptoms in addition to attending regular outpatient clinic appointments in order to facilitate early management if needed. Furthermore, it is highly important for physicians to assess newborns for hypospadias before carrying out circumcision as it is a contraindication for the procedure.

MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES

You have accessJournal of UrologyCME1 Apr 2023MP74-01 CHARACTERISATION OF FEMALE URETHRAL STRICTURES Elizabeth Day, Helena Gresty, Anthony Noah, Richard Nobrega, Jeremy Ockrim, and Tamsin Greenwell Elizabeth DayElizabeth Day More articles by this author , Helena GrestyHelena Gresty More articles by this author , Anthony NoahAnthony Noah More articles by this author , Richard NobregaRichard Nobrega More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003348.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Female urethral stricture (FUS) is rare. We have assessed the history, imaging and urodynamic characteristics of all women seeking urethroplasty for recurrent symptomatic strictures. METHODS: A retrospective review of 63 consecutive women (median age 50.5 years, range 25-71) with recurrent or refractory FUS undergoing urethroplasty since June 2012. Data was analysed for symptom profile, aetiology and previous therapy. MRI, videourodynamic (VUDS) and examination findings provided stricture length and site. RESULTS: Median duration of symptoms was 60 months (range 24-456). The commonest symptoms were poor flow 61 (97%), frequency 48 (76%), nocturia 46 (73%), urgency 44 (70%), recurrent UTI 41 (65%) and urethral pain 40 (63%). The commonest causes of FUS are, unknown in 37 (59.7%), urethral instrumentation/catheterisation in 7 (11.1%), urethral diverticulum excision in 4 (6%), radiotherapy in 3 (4.7%), none relaxing sphincter in 3 (4.7%) and lichen planus in 2 (3.2%). The women had had a median of 5 previous urethral dilatations (range 0-33). 38 (60%) had been performing ISC for a mean of 24 months (range 6-120) and 31 (82%) found it painful. Pre-operative MRI pelvis was performed in 56 (89%) and revealed a concentrically thickened urethra in 35 (63%), urethral diverticulum in 4 (6%), an absent/fibrotic urethra in 4 (6%), and no abnormalities in 13 (21%). Pre-operative VUDS were performed in 57 (90%). Bladder outflow obstruction (BOO) was seen in 56 (98%). Preoperatively median Qmax was 5 mls/s (range 0-24), median Pdet Q max was 70 cm H2O (range 0-165) and median Solomon-Greenwell BOOIf was 51.4 (range -24.2-156.2) (where BOOIf >5 =>50% chance of BOO). Other findings included detrusor overactivity in 22 (39%) and stress urinary incontinence in 7 (12%).Median stricture length was 2.0 cm (range 0.5-4.0 cm) and the commonest sites were mid-distal in 20 (32%) and distal in 19 (30%). 53 (84%) had ventral onlay buccal mucosal graft urethroplasty, 6 (10%) had ventral vaginal flap urethroplasty, 2 (3%) had ventral onlay labial minora flap urethroplasty and 1 (1.5%) had a ventral vaginal graft urethroplasty – with stricture free status in 55 (87%) at last follow-up (median 39 months, range 4-112). CONCLUSIONS: Poor flow is present in almost all women with FUS. The majority will also have irritative LUTS, recurrent UTIs and urethral pain. VUDS and MRI are useful pre-operatively to characterise the stricture. Definitive treatment with urethroplasty should be considered earlier once endoscopic management has failed. Source of Funding: Nil © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1069 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Elizabeth Day More articles by this author Helena Gresty More articles by this author Anthony Noah More articles by this author Richard Nobrega More articles by this author Jeremy Ockrim More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement PDF downloadLoading ...

Stress urinary incontinence following urethral diverticulum excision: Incidence and management

Stress urinary incontinence following urethral diverticulum excision: Incidence and management

598. EPIPHRENIC DIVERTICULUM CAUSING GASTROESOPHAGEAL JUNCTION OUTFLOW OBSTRUCTION (EGJOO)

Abstract Oesophageal diverticulum is a rare cause of dysphagia. They are classified based on location- Zenker’s diverticulum distal to the cricopharyngeus; epiphrenic diverticulum above the lower oesophageal sphincter (LES)- or pathophysiology – traction vs pulsion. The prevalence of epiphrenic pulsion diverticulum ranges from 0.2% to 0.8%. We present a case of epiphrenic diverticulum and its management. A 68 year old lady presents with dysphagia to solids and liquids, belching, food regurgitation, and acid brash for 10 years. She had no loss of weight, but experienced daily regurgitation and occasional retrosternal pain. Physical examination was unremarkable. We worked her up with further investigations and scans. A CT abdomen reported a hiatus hernia and mural thickening of distal oesophagus with upstream oesophageal distension. A oesophagogastroduodenoscopy showed residual food in oesophagus. The lower oesophagus was dilated and the LES appeared tight with no masses. There was no hiatus hernia on endoscopy. Barium swallow revealed the lower oesophageal dilatation to be an epiphrenic diverticulum. Manometry studies showed oesophago-gastric junction outflow obstruction. She underwent laparoscopic excision of esophageal diverticulum, cardiomyotomy and anterior partial fundoplication. The video serves to highlight the surgical key steps. She was discharged on post-operative day 3 without complications and barium swallow pre/post op as shown. Oesophageal diverticulum, although rare, remains a differential for dysphagia. For epiphrenic diverticulum, it is important to understand that this is a pulsion diverticulum, with an accompanying gastro-oesophageal outflow obstruction. In addition to surgical management with a laparoscopic diverticulectomy, a cardiomyotomy and partial fundoplication to treat underlying motility disorder is important. This case study and video serves to highlight the condition and present minimally invasive surgical management.

Open Esophageal Procedures

The growing stature of minimally invasive approaches to esophageal diseases does not diminish the importance of the equivalent open approaches. This chapter describes common open operations performed to excise Zenker diverticulum, to manage complex gastroesophageal reflux disease, and to resect esophageal and proximal gastric tumors. For each of these open procedures, the preoperative evaluation, operative planning, steps of the operative techniques, postoperative care, complications, and outcome evaluation are described. Over two dozen figures show many of the operative steps for a cricopharyngeal myotomy and excision of Zenker diverticulum, a transthoracic hiatal hernia repair, a transhiatal esophagectomy, Ivor-Lewis esophagectomy, and a left thoracoabdominal esophagogastrectomy. This review contains 27 figures, 21 tables, 14 references Keywords: Zenker diverticulum, esophageal cancer, gastroesophageal reflux disease, gastric tumor, cricopharyngeal myotomy, transthoracic hiatal hernia repair, transhiatal esophagectomy, Ivor-Lewis esophagectomy, left thoracoabdominal esophagogastrectomy

MP56-04 THE PRESENTATION, MANAGEMENT AND OUTCOME OF FEMALE URETHRAL DIVERTICULUM SURGERY – DIFFERENT BUT EQUALLY EFFECTIVE EITHER SIDE OF THE POND

You have accessJournal of UrologyTrauma/Reconstruction/Diversion: Urethral Reconstruction (including Stricture, Diverticulum) III (MP56)1 Sep 2021MP56-04 THE PRESENTATION, MANAGEMENT AND OUTCOME OF FEMALE URETHRAL DIVERTICULUM SURGERY – DIFFERENT BUT EQUALLY EFFECTIVE EITHER SIDE OF THE POND Rachel Barratt, Catherine Culp, Helena Gresty, Jeremy Ockrim, Eric Rovner, and Tamsin Greenwell Rachel BarrattRachel Barratt More articles by this author , Catherine CulpCatherine Culp More articles by this author , Helena GrestyHelena Gresty More articles by this author , Jeremy OckrimJeremy Ockrim More articles by this author , Eric RovnerEric Rovner More articles by this author , and Tamsin GreenwellTamsin Greenwell More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002086.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To assess symptomatic and functional outcomes of urethral diverticulum excision in women and to compare management and outcomes at 2 high volume centres – 1 in the UK and 1 in the USA. METHODS: Retrospective review of the notes and imaging of all female patients having excision of a symptomatic urethral diverticulum between 2004 and 2018 for symptomatic urethral diverticulum. Data on patient demographics, urethral diverticulum characteristics and outcomes in particular symptomatic resolution, diverticulum recurrence and persistent/new onset urinary incontinece were noted.Statistical analysis was by Students T -Test and Chi-Squared. Significance was taken as P< 0.05. RESULTS: 191 women median age 45 years (range 19-78) had excision of their urethral diverticulum +/- Martius Fat Pad Interposition (N= 131) during the study period. 21(11%) patients had a simultaneous pubovaginal sling (PVS) or mid-urethral tape (MUT). 169 (88%) had preoperative pelvic MRI, 134 (79.2%) had pre-operative video-urodynamics and 124 (65%) had a complex urethral diverticulum.2 (1%) women had symptomatic and 3 (1.5%) had asymptomatic (on MRI only) urethral diverticulum recurrence at a mean follow-up of 24.2 months (range 0-156). Urinary incontinence was present in 164 (85.8%) pre-operatively and 64(33.5%) post-operatively; 32 (16.8%) of whom rated their incontinence as mild. Other symptomatic outcomes are detailed in Table 1: *P < 0.05 CONCLUSIONS: The commonest symptoms of urethral diverticulum are lump in the vagina, urethral or vaginal pain and dysuria. Following excision, the majority of symptoms resolve with urethral discharge most likely and frequency/urgency least likely to resolve. There are significant differences in outcomes for post-micturition dribble, urethral or vaginal pain, poor flow, recurrent UTIs and frequency/urgency between the 2 centres which most likely represent patient and diverticulum factors rather than treatment factors. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e970-e970 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rachel Barratt More articles by this author Catherine Culp More articles by this author Helena Gresty More articles by this author Jeremy Ockrim More articles by this author Eric Rovner More articles by this author Tamsin Greenwell More articles by this author Expand All Advertisement Loading ...

Robotic assisted retrovesical approach to prostatic utricle excision and other complex pelvic pathology in children is safe and feasible

Excision of the prostatic utricle has been a challenging surgical problem due to the location deep in the pelvis between the rectum and bladder. Robotic-assisted laparoscopic surgery allows minimally invasive access to this location. To describe the robotic surgical outcomes and important techniques associated with robotic excision of the prostatic utricle and explain how these techniques apply to similar pediatric pelvic pathology. Retrospective chart evaluation of patients treated at a single institution with robotic excision of a prostatic utricle as well as two other patients in which the similar approach was employed. 4 patients underwent robotic excision of a prostatic utricle. A fifth patient underwent excision of urethral diverticulum that was the remnant of an ectopic ureter. The sixth patient had a high urogenital sinus that required laparoscopic assisted vaginoplasty approached in a similar manner to the above listed cases. Mean age at surgery was 35.5 months for the utricle patients. Mean follow-up duration for the utricle patients was 30.75 months. Average hospital stay for the utricle patients was one day. In the utricle patients one patient developed transient urinary retention and one had a postoperative urinary tract infection. Concomitant cystoscopy used in the two non-utricle patients was a key step in defining the proper location of dissection. Robotic-assisted laparoscopic retrovesical excision of the prostatic utricle is a safe operation that requires a skill set that can be readily applied to other complex pelvic pathology such as the ectopic ureter, urethral diverticulum, and urogenital sinus. Concomitant cystoscopy can aid significantly in defining the location and limits of dissection.

Comparison of Supine and Prone Positioning in Female Patients Undergoing Urethral Diverticulum Excision

Comparison of Supine and Prone Positioning in Female Patients Undergoing Urethral Diverticulum Excision

708 - Continence outcomes after urethral diverticulum excision

708 - Continence outcomes after urethral diverticulum excision

699 - Pre-operative MRI findings and predictors of De Novo stress urinary incontinence after urethral diverticulum excision

699 - Pre-operative MRI findings and predictors of De Novo stress urinary incontinence after urethral diverticulum excision

Case study: urethral diverticulum with calcifications in a premenopausal woman

Female urethral diverticulum is a fairly rare pathology, the frequency of which ranges from 0.02 to 6.00% of women worldwide. The stones inside urethra diverticulum even more rare. The most common reasons of urethral diverticula are frequent bladder catheterizations, labour trauma, infections. Clinically is may present with the dysuria, dyspareunia, dribble, urinary incontinence, vaginal discomfort. Voiding cystourethrography and cystourethroscopy are the most accurate methods of diagnosis for urethral diverticula. The presented article describes the clinical case in women with urethral diverticulum who complained on the vaginal discomfort, dyspareunia and presentation of the brown stones in vagina and underwent surgical excision of diverticulum with urethral reconstruction.

Axial Torsion and Meckel’s Diverticulitis: A Diagnostic Conundrum

Introduction: Meckel’s diverticulum is one the most common congenital anomalies of gastrointestinal tract that mimics acute appendicitis, gastroenteritis, peptic ulcer disease. Complications related to it can be haemorrhage, intestinal obstruction, perforation while axial torsion is one of the rarest complications. So, this paper objectifies a rare clinical scenario that we encountered in our practice and highlights on the possible management strategies. Case : An 11 year boy presented with a history of pain at peri-umbilical region for four days with 2-3 episodes of vomiting. Abdominal examination revealed tenderness at suprapubic area with a mass around 5x3 cm along hypogastrium. Ultrasonography abdomen revealed an avascular structure in central area with clumping of bowel and omentum over the lesion while computed tomography scan of abdomen revealed blind ended gas filled structure at hypogastrium with thickened enhancing irregular wall associated with adjacent mesenteric fat plane stranding and prominent adjacent axial vessels supplying inflammatory lesion. Exploratory laparotomy showed axial twisting of diverticulum about 10x5 cm arising from anti-mesenteric border around 50 cm proximal to ileo-caecal junction with a fibrous band attached to the fundus and ileum leading to gangrenous diverticulum with clumping of bowel loops along with omental covering. De-twisting and adhesiolysis along with excision of the diverticulum was done with two layered closure of the defect. Conclusion: Axial torsion is the rarest of the complication of MD and should be managed with utmost caution. Excision of the twisted diverticulum with or without wedge resection of the involved ileum is the procedure of choice.

Robotic surgery in paediatric patients: Our initial experience and roadmap for successful implementation of robotic surgery programme.

Introduction:The popularity of robot-assisted surgeries has accelerated since its advent in 1990s. Recently, we procured da Vinci surgical system in our institution; and here, we present our initial experience of robot-assisted surgeries at our hospital. We also discuss the stepwise approach for successful implementation of the robotic surgical programme at our institute. Moreover, the importance of efficient use of this advanced but expensive technology has been highlighted.Materials and Methods:Retrospective analysis of the medical record of all the paediatric patients between the age ranges of 1–18 years who had undergone robotic-assisted laparoscopic surgery during April 2019–April 2019 was done. Medical record was reviewed for descriptive data, clinical presentation, investigations, operative details and follow-up. Statistical data were also obtained from medical superintendent office.Results:During April 2018–April 2019, total of 111 cases were operated across six specialities. Approximately 73% of cases (81/111) belonged to adult urology and gynaecology speciality. Less than 5% (5/111) of patients were in paediatric age group. The department of paediatric surgery performed one pyeloplasty, 3 ureteric reimplantation and 1 bladder diverticulum excision with robot assistance. The operative duration of the cases was comparable to the standard laparoscopic techniques. All patients are asymptomatic on follow-up visits.Conclusion:The robotic surgery is feasible in paediatric population and has favourable post-operative outcomes. Detailed planning and stepwise approach is key to the establishment of new robotic surgery programme in any institute.

A rare cause of acute abdomen: Isolated necrosis of the cecum.

We would like to present the case of a 76-year-old female patient with cecal necrosis, which is a rare cause of acute abdomen in elderly women and a variant of ischemic colitis. The patient was admitted to our hospital with abdominal pain, anorexia, and nausea. Physical examination, laboratory parameters, and abdominal computed tomography revealed acute abdomen. We operated the patient with an infra-umbilical midline incision. Considering the pain localized to the right lower quadrant, our initial diagnosis was acute appendicitis; however, we kept in mind other differential diagnoses as well. After laparotomy Non-occlusive cecal necrosis was detected. Arterial pulse was palpated; however, no signs of trombus were detected. Patient also have a Meckel's diverticulum. Terminal ileum plus cecum resection and Meckel's diverticulum excision were performed. Isolated necrosis of the cecum may be caused due to multiple reasons. Especially in elderly female patients with predisposing factors like hypotension, sepsis, shock, drug use, vasculitis, and hypercoagulability, cecal necrosis should be kept in mind.

V17 - Robotic radical prostatectomy and excision of bladder diverticulum

V17 - Robotic radical prostatectomy and excision of bladder diverticulum

The Surgeon Volume-outcome Relationship: Not Yet Ready for Policy.

Increasing surgeon volume may improve outcomes for index operations. We hypothesized that there may be surrogate operative experiences that yield similar outcomes for surgeons with a low-volume experience with a specific index operation, such as esophagectomy. The relationship between surgeon volume and outcomes has potential implications for credentialing of surgeons. Restrictions of privileges based on surgeon volume are only reasonable if there is no substitute for direct experience with the index operation. This study was aimed at determining whether there are valid surrogates for direct experience with a sample index operation-open esophagectomy. The Nationwide Inpatient Sample (2003-2009) was utilized. Surgeons were stratified into low and high-volume groups based on annual volume of esophagectomy. Surrogate volume was defined as the aggregate annual volume per surgeon of upper gastrointestinal operations including excision of esophageal diverticulum, gastrectomy, gastroduodenectomy, and repair of diaphragmatic hernia. In all, 26,795 esophagectomies were performed nationwide (2003-2009), with a crude inhospital mortality rate of 5.2%. Inhospital mortality decreased with increasing volume of esophagectomies performed annually: 7.7% and 3.8% for low and high-volume surgeons, respectively (P < 0.0001). Among surgeons with a low-volume esophagectomy experience, increasing volume of surrogate operations improved the outcomes observed for esophagectomy: 9.7%, 7.1%, and 4.3% for low, medium, and high-surrogate-volume surgeons, respectively (P = 0.016). Both operation-specific volume and surrogate volume are significant predictors of inhospital mortality for esophagectomy. Based on these observations, it would be premature to limit hospital privileges based solely on operation-specific surgeon volume criteria.

An innovative method of surgical excision of duodenal diverticulum in a 17-year-old girl

An innovative method of surgical excision of duodenal diverticulum in a 17-year-old girl

Ureteric diverticulum: A diagnostic challenge

Ureteric diverticulum is a rare urological condition with only 47 cases described in the literature till 2013. A full term female infant presented with a huge cystic lump occupying almost the entire right side of the abdomen at 1 month of age. Ultrasonography and Magnetic Resonance Urography (MRU) revealed right sided gross hydronephrosis with pelvis appeared folded onto itself along with left sided mild hydronephrosis. On EC scan, differential function of right sided kidney was 0.9%. With working diagnosis of right sided giant hydronephrosis secondary to pelviureteric junction obstruction, the child was posted for Anderson - Hynes pyeloplasty through right flank incision. On exploration we were surprised to find ureteric diverticula. Excision of ureteric diverticulum with proximal ureterostomy was done. Distal part of ureter was transfixed. Histopathological examination of diverticulum showed presence of fibromuscular wall suggestive of true diverticulum. Since ureterostomy was draining only few drops of clear fluid and on repeat EC scan there was no improvement in function of right kidney, right nephroureterectomy was done after 6 months.