Urethral diverticulum, a sac-like protrusion communicating with the urethral lumen, is a relatively uncommon occurrence. It represents either an infected paraurethral gland that has ruptured in the urethra or a prolapse of the urethral wall through a defect in the periurethral fascia. The classic clinical presentation is a soft, slightly tender vaginal lesion causing dysuria, dyspareunia and dribbling incontinence. Unfortunately, this classic presentation is only seldom seen. The condition may be either asymptomatic or manifest nonspecific symptoms of any lower genitourinary tract pathology. In the majority of cases, diagnosis relies on imaging, with MRI becoming the technique of choice, as it is accurate and provides detailed anatomical information. Complete excision of the diverticular sac with meticulous urethral and periurethral reconstruction is the 'gold standard' treatment. Success rates of 70-100% have been reported, with a few complications occurring, particularly in cases of large and complex diverticula.
INTRODUCTION AND OBJECTIVE: Antimuscarinic drugs are the first-line choice in the treatment of patients with neurogenic Detrusor Overactivity (nDO). Fesoterodine fumarate is the newest antimuscarinic drug. Limited data are published about the use of Fesoterodine fumarate in patients suffering from Neurogenic Lower Urinary Tract Dysfunction (NLUTD). Our study aims to determine the efficacy of Fesoterodine fumarate on patients with nDO due to Spinal Cord Lesion (SCL) or Multiple sclerosis (MS) METHODS: This is an open-label prospective interventional study. Eligible patients were 18-80 years old with SCL or MS and nDO confirmed by a urodynamic study (UDS). At baseline, patients underwent a UDS to confirm nDO. Quality of life (QoL) was assessed by the SF (Short-Form) Qualiveen questionnaire. Patients received fesoterodine 8 mg/d for 3 months and were re-evaluated with UDS and SF-Qualiveen. The primary endpoint was the confirmation of the maximum detrusor pressure (P detmax ) reduction after treatment. Secondary endpoints were the evaluation of maximum bladder capacity and compliance and the effect on QoL. Statistical analysis performed by Wilcoxon-test using SPSSv26.RESULTS: 124 patients completed the study. 95 of them (76.6%) had SCL, while 29 (23.4%) had MS. P detmax had a significant reduction, while bladder capacity and compliance were improved after treatment in the whole and individual subgroups (p <0.001). SF-Qualiveen revealed a significant increase (p <0.001) in QoL in the whole group and each subgroup.CONCLUSIONS: Fesoterodine fumarate is effective against NDO in favour of Upper Urinary Tract protection for patients with Spinal Cord Lesion or Multiple Sclerosis, improving the urodynamic parameters and QoL, independently of the underlying neurological disease.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.