TY - JOUR T1 - Management of symptomatic urethral diverticula in women: a single-centre experience. AU - Reeves,Felicity A, AU - Inman,Richard D, AU - Chapple,Christopher R, Y1 - 2014/02/26/ PY - 2013/11/22/received PY - 2014/02/17/accepted PY - 2014/3/19/entrez PY - 2014/3/19/pubmed PY - 2015/2/14/medline KW - Female LUTS KW - Paraurethral glands KW - Urethral diverticula KW - Urethral diverticulectomy KW - Urinary incontinence SP - 164 EP - 72 JF - European urology JO - Eur Urol VL - 66 IS - 1 N2 - BACKGROUND: Urethral diverticula (UDs) affect between 1% and 6% of adult women. A total of 1.4% of women with stress urinary incontinence (SUI) have a UD. Clinically significant diverticula are rare and can be challenging to manage. OBJECTIVE: To review results of surgery on UDs in a single surgical centre. DESIGN, SETTING, AND PARTICIPANTS: We retrospectively evaluated a group of 89 patients with symptomatic UDs referred for surgical intervention to one teaching hospital. Data were from two surgeons over an 8-yr period between October 2004 and November 2012. Follow-up period ranged from 3 mo to 20 mo, and all patients were physically reviewed postoperatively in an outpatient setting. INTERVENTION: The surgical technique involved placing the patient prone, ureteric catheterisation, dissection and removal of the diverticulum, and layered closure. Where a large defect was present following excision, a Martius flap was interposed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Outcome data collected included symptomatic cure, continence, de novo SUI, early versus late complications, and recurrence. RESULTS AND LIMITATIONS: Early complications included one urinary tract infection and one Martius graft infection, both requiring intravenous antibiotics. Overall, 72% of patients were dry and cured postoperatively; 13 patients had de novo SUI following surgery. Those with bothersome SUI went on to have an autologous sling at 6 mo. All were dry; three (23%) required clean intermittent self-catheterisation. Three patients had a recurrent residual diverticulum (3.4%) following surgery. One chose conservative management. The other two had a redo diverticulectomy performed via a dorsal approach. They have recovered well and are dry. Two (2.2%) diverticula revealed unexpected abnormal pathology. The first was a leiomyoma; the second was a squamous cell carcinoma requiring further surgery. CONCLUSIONS: The recommended preoperative imaging is postvoid sagittal magnetic resonance imaging and appropriate use of urodynamic assessment at baseline. The 72% dry rate (including a number with preoperative incontinence) is comparable with the literature as is the development of de novo SUI in 15% of patients. There is a small risk of unexpected tumours (2%). PATIENT SUMMARY: A urethral diverticulum should be excluded as a diagnosis in anyone troubled by symptoms of a swelling of the urethra often associated with discomfort, pain on intercourse, urinary dribbling after passing urine, and/or recurrent urinary infections. In these circumstances patients should seek advice from their doctors and consider referral for a specialist assessment. If the diagnosis is made and the problem is symptomatic, surgery is likely to resolve the problem but should be carried out in a specialist centre with expertise in the management of this condition. SN - 1873-7560 UR - https://www.unboundmedicine.com/medline/citation/24636677/Management_of_symptomatic_urethral_diverticula_in_women:_a_single_centre_experience_ DB - PRIME DP - Unbound Medicine ER -