Incidence of female urethral diverticulum: a population-based analysis and literature review

El-Nashar, Sherif A.; Bacon, Melissa M.; Kim-Fine, Shunaha; Weaver, Amy L.; Gebhart, John B.; Klingele, Christopher J.

doi:10.1007/s00192-013-2155-2

Cited by 73 publications

(59 citation statements)

References 19 publications

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“…UD is a rare condition that affects 6-20 in 1,000,000 women [1,2] in population-based studies. However, UD may be found in up to 1.4 % of women presenting for evaluation of urinary incontinence [3] and in over 80 % of patients presenting with periurethral masses [4].…”

Section: Epidemiology and Etiologymentioning

confidence: 99%

Female Urethral Diverticulum: Current Diagnosis and Management

Crescenze

Goldman

2015

Curr Urol Rep

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While urethral diverticulum (UD) affects less than 20 per 1,000,000 women overall, it is thought to represent 1.4% of women with incontinence presenting to urology practices. It is hypothesized to evolve from periurethral glands that become obstructed, infected, and dilated over time, and patients typically present with dyspareunia, bothersome lower urinary tract symptoms (LUTS), and/or recurrent UTIs. In many patients, a periurethral mass can be appreciated on exam. In recent years, magnetic resonance imaging (MRI) has become the imaging test of choice for diagnosis of UD, but ultrasound (US) is a readily available alternative and provides good specificity at a lower cost. Surgical excision of the diverticulum with tension-free, water-tight, three-layer closure continues to be the mainstay of treatment of UD with most studies reporting cure rates of >90%. Concomitant treatment of preexisting stress incontinence with autologous fascial pubovaginal sling can be used at the time of diverticulectomy to avoid a secondary procedure. However, since secondary anti-incontinence procedures are needed in only a small number of patients, up-front stress incontinence treatment may result in significant overtreatment, and staged anti-incontinence procedures continue to be a reasonable option for patients with persistent bothersome stress urinary incontinence (SUI) after diverticulectomy.

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Section: Epidemiology and Etiologymentioning

confidence: 99%

Female Urethral Diverticulum: Current Diagnosis and Management

Crescenze

Goldman

2015

Curr Urol Rep

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“…The details can be found in our previously published study describing the incidence of UD with 16 patients who were used in the prior epidemiologic incidence publication were included in this study. 1 …”

Section: Methodsmentioning

confidence: 99%

“…1 Urethral diverticulum can be congenital or acquired. The diagnosis of UD may be suggested by a thorough clinical history and physical examination but often imaging is required to confirm the findings of clinical evaluation.…”

mentioning

confidence: 99%

Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery

El-Nashar

Singh

Bacon

et al. 2016

Female Pelvic Med Reconstr Surg

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Introduction and Hypothesis To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD). Methods Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded. Outcomes after surgery were assessed using survival analysis. All statistical analyses were 2-sided and P values less than 0.05 were considered significant. Statistical analysis was done using SAS version 9.2 and JMP version 9.0 (SAS Institute Inc.). Results A total of 164 cases were identified. Median age at diagnosis was 46 years (range, 21–83). The most common presenting symptom was recurrent urinary tract infection (98, 59.8%), followed by urinary incontinence (81, 49.4%), dysuria (62, 37.8%), dyspareunia (37, 22.6%), and hematuria (15, 9.1%). Examination revealed vaginal mass in 55 (33.5%) of the women. A significant trend was noted toward an increase in use of both magnetic resonance imaging and computed tomography (P < 0.001) along with a progressive decrease in use of urethrogram (P < 0.001) for diagnosis of UD over the years. Among 114 women who underwent surgical treatment for UD, 14(12.3%) women presented with recurrent UD and the 5-year recurrence rate after surgery for UD was 23.4% (95% confidence interval, 13.9–37.0) and a reoperation rate of 17.0% (95% confidence interval, 8.8–30.2) at 5 years. Conclusions Female UD is a rare and unique condition. Clinical presentation is usually nonspecific, and magnetic resonance imaging is commonly used for confirming the diagnosis. Recurrence is not uncommon, and repeat surgical intervention might be needed.

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“…Urethral diverticula (UD) affect 6-20 in 1,000,000 of the general population but may be observed in up to 1.4% of those with urinary incontinence [35–37]. Most probably UD develop from the periurethral glands obstructed and dilated as a consequence of chronic inflammation [38, 39].…”

Section: Role Of Ultrasound Imaging In the Clinical Work-up Of Patienmentioning

confidence: 99%

Ultrasound imaging in urogynecology – state of the art 2016

Bogusiewicz

2016

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The role of ultrasound imaging in urogynecology is not clearly defined. Despite significant developments in visualization techniques and interpretation of images, pelvic ultrasound is still more a tool for research than for clinical practice. Structures of the lower genitourinary tract and pelvic floor can be visualized from different approaches: transperineal, introital, transvaginal, abdominal or endoanal. According to contemporary guidelines and recommendations, the role of ultrasound in urogynecology is limited to the measurement of post-void residue. However, in many instances, including planning and audit of surgical procedures, management of recurrences or complications, ultrasound may be proposed as the initial examination of choice. Ultrasound may be used for assessment of bladder neck mobility before anti-incontinence procedures. On rare occasions it is helpful in recognition of pathologies mimicking vaginal prolapse such as vaginal cyst, urethral diverticula or rectal intussusception. In patients subjected to suburethral slings, causes of surgery failure or postsurgical voiding dysfunctions can be revealed by imaging. Many reports link the location of a tape close to the bladder neck to unfavorable outcomes of sling surgery. Some postoperative complications, such as urinary retention, mesh malposition, hematoma, or urinary tract injury, can be diagnosed by ultrasound. On the other hand, the clinical value of some applications of ultrasound in urogynecology, for example measurement of the bladder wall thickness as a marker of detrusor overactivity, has not been proved.

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Incidence of female urethral diverticulum: a population-based analysis and literature review

Cited by 73 publications

References 19 publications

Female Urethral Diverticulum: Current Diagnosis and Management

Female Urethral Diverticulum: Current Diagnosis and Management

Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery

Ultrasound imaging in urogynecology – state of the art 2016

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