Urinary Symptoms Before and After Female Urethral Diverticulectomy—Can We Predict De Novo Stress Urinary Incontinence?

Stav, Kobi; Dwyer, Peter; Rosamilia, Anna; Chao, Fay

doi:10.1016/j.juro.2008.07.049

Cited by 50 publications

(63 citation statements)

References 15 publications

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“…In the office, cystourethroscopy can be used to visualize the location of the diverticular ostium in 15-77 % of the cases [13,14,16,18] and is a helpful and important tool in the diagnosis and surgical planning. It is performed by slowly withdrawing the cystoscope through the urethra in order to visualize the ostium of the diverticulum, usually located posteriolaterally.…”

Section: Discussionmentioning

confidence: 99%

“…Because these symptoms can overlap with multiple other conditions, there is often a significant delay to diagnosis of up to 2-5 years [13,14]. A high index of suspicion has to be maintained, especially in women with persistent lower urinary tract symptoms and the absence of an alternative diagnosis.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Because of the potential risk of complications and minimal patient bother [5••, 42] Additionally, since UD may mask SUI pre-operatively due to mass effect, staged sling placement may be necessary for treatment of de novo SUI which has been reported to occur in about 10-33 % of cases [5••, 13, 27, 38, 42]. It is associated with diverticular size >3 cm and more proximal location of the diverticulum [13]. Overall, 4-10 % of patients undergo secondary anti-incontinence procedures after diverticulectomy [13,27,42], and it is usually done about 6-8 months after initial surgery [5••, 13, 42].…”

Section: Anti-incontinence Proceduresmentioning

confidence: 99%

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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: Discussionmentioning

confidence: 99%

Section: Clinical Presentationmentioning

confidence: 99%

Section: Anti-incontinence Proceduresmentioning

confidence: 99%

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Female Urethral Diverticulum: Current Diagnosis and Management

Crescenze

Goldman

2015

Curr Urol Rep

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“…Fistula occurred in three (7.7%) out of the 39 patients of diverticulectomies in one series [61], and de novo SUI developed in four (16%) patients postoperatively in another [17]. In an older publication, there were two cases of diverticulum recurrence and one of urethro vaginal fistula in 68 patients [33].…”

Section: Results Of Diverticulectomymentioning

confidence: 99%

“…The classic postvoid dribbling was reported by only one patient (4.5%). Urgency and frequency are also very common, with rates as high as 60% [17].…”

Section: Clinical Presentationmentioning

confidence: 99%

Female urethral diverticula: from pathogenesis to management. An update

Giannitsas

Athanasopoulos²

2010

Expert Review of Obstetrics & Gynecology

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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.

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