Despite an incidence of 3–40% in different populations, a diagnosis of urethral diverticulum in female patients is often delayed or missed. A 49-year-old multiparous woman presented complaining of severe, refractory urinary urgency and frequency and urge incontinence, in addition to dysuria and pelvic pain for several years. The diagnosis of an anterior urethral diverticulum was made based on findings at magnetic resonance imaging. Surgical management was accomplished vaginally without significant urethral disruption. At 5 months postoperatively, the patient was markedly improved. Lower urinary tract pathology can create a diagnostic and surgical dilemma, which necessitates a thorough evaluation and careful management to achieve a satisfactory outcome.