Objective: Transvaginal excision of urethral diverticulum (UD) is the gold standard treatment for symptomatic women with UD. Complete UDexcision can be challenging due to poor access to the surgical field, especially with proximal, circumferential and recurrent UD. Prone patientpositioning has been suggested as an effective way of improving surgical access and vision compared to the traditional supine positioning. However,direct comparison of the two positions is yet to be performed. This study aimed to compare patients who underwent UD excision in prone andsupine positions.Materials and Methods: Prospectively recorded data of 79 women undergoing urethral diverticulectomy between 2004 and 2017 in a singlereferral centre were reviewed. Patients were operated either in supine or prone positions based on the surgeon’s preference. Data collected includedpatient demographics, UD characteristics on magnetic resonance imaging, intraoperative details and postoperative outcomes. Operative time wascalculated from the electronic theatre records starting from the entry of the patient into the operating room to their exit.Results: The mean patient age was 42.38 (±15.24) years. More than half of the patients had a recurrent UD at presentation (51.89%). The mean sizeof the diverticulum was 25.06 (±1.2) mm, and the mean operative time was 146.18 (±6.0) min. UD excision was undertaken in prone position in 50(63.3%) and supine position in 29 (36.7%) patients. Patients in the prone position group were older and had relatively larger and proximal UD. In themultivariable analysis, it was found that a proximally located UD was the main indicator for undergoing surgery in the prone position.Conclusion: Despite longer operative times, prone patient posit