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The incidence and outcomes of urodynamic stress urinary incontinence in female patients with urethral diverticulum.

Abstract

AIMS

To assess the incidence and management of urodynamic stress urinary incontinence (USUI) in women undergoing transvaginal excision of a urethral diverticulum (UD) at our institution.

METHODS

A prospective database, capturing patients undergoing urethral diverticulectomy over a 9-year period (May 2007 to August 2016), was reviewed focusing on USUI and subsequent management.

RESULTS

One hundred patients underwent UD excision (with modified Martius labial fat-pad flap interposition). Preoperative magnetic resonance imaging data, available in 90 patients, demonstrated that 80% had complex diverticula. Complete urodynamic data were available for 93 patients. Preoperatively, 27 patients (29%) had USUI of which 16 patients resolved with either UD excision alone (n = 8) or 3 months of pelvic floor muscle therapy (PFMT) (n = 8). All 11 with persistent postoperative USUI had video urodynamics (VUDs) confirming Blaivas type 3 USUI. Six patients had a rectus fascial pubovaginal sling (RFPVS) with success in five (83.3%) while five had a mid-urethral obturator tape (MUT-O) with 100% success. Sixteen patients developed de novo stress urinary incontinence (SUI) postoperatively, with resolution after PFMT in 12 (75%). VUDS identified USUI (Blaivas type 3) in two (of the remaining four) patients, managed successfully with MUT-O (n = 1) and RFPVS (n = 1).

CONCLUSION

Preoperative USUI is present in 29% with UD. Postoperatively, 35.5% (n = 33) have pre-existing (19) or de novo (14) SUI, of which 60.6% (n = 20) resolves after 12 months of conservative management. Surgery for USUI is required in 13 (13.9%), with cure in 92.3%. This supports our practice to excise UD primarily and delay USUI surgery, therefore, avoiding overtreatment for the majority.

Authors+Show Affiliations

Department of Urology, UCLH, London, UK.Department of Urology, Guys and St Thomas' NHS Foundation Trust, London, UK.Department of Urology, UCLH, London, UK.Department of Urology, UCLH, London, UK.Department of Urology, UCLH, London, UK.Department of Urology, UCLH, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31270839

Citation

Barratt, Rachel, et al. "The Incidence and Outcomes of Urodynamic Stress Urinary Incontinence in Female Patients With Urethral Diverticulum." Neurourology and Urodynamics, 2019.
Barratt R, Malde S, Pakzad M, et al. The incidence and outcomes of urodynamic stress urinary incontinence in female patients with urethral diverticulum. Neurourol Urodyn. 2019.
Barratt, R., Malde, S., Pakzad, M., Hamid, R., Ockrim, J., & Greenwell, T. (2019). The incidence and outcomes of urodynamic stress urinary incontinence in female patients with urethral diverticulum. Neurourology and Urodynamics, doi:10.1002/nau.24090.
Barratt R, et al. The Incidence and Outcomes of Urodynamic Stress Urinary Incontinence in Female Patients With Urethral Diverticulum. Neurourol Urodyn. 2019 Jul 3; PubMed PMID: 31270839.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The incidence and outcomes of urodynamic stress urinary incontinence in female patients with urethral diverticulum. AU - Barratt,Rachel, AU - Malde,Sachin, AU - Pakzad,Mahreen, AU - Hamid,Rizwan, AU - Ockrim,Jeremy, AU - Greenwell,Tamsin, Y1 - 2019/07/03/ PY - 2019/03/14/received PY - 2019/05/27/accepted PY - 2019/7/5/entrez KW - diverticulum KW - female KW - reconstruction KW - stress urinary incontinence KW - urethra JF - Neurourology and urodynamics JO - Neurourol. Urodyn. N2 - AIMS: To assess the incidence and management of urodynamic stress urinary incontinence (USUI) in women undergoing transvaginal excision of a urethral diverticulum (UD) at our institution. METHODS: A prospective database, capturing patients undergoing urethral diverticulectomy over a 9-year period (May 2007 to August 2016), was reviewed focusing on USUI and subsequent management. RESULTS: One hundred patients underwent UD excision (with modified Martius labial fat-pad flap interposition). Preoperative magnetic resonance imaging data, available in 90 patients, demonstrated that 80% had complex diverticula. Complete urodynamic data were available for 93 patients. Preoperatively, 27 patients (29%) had USUI of which 16 patients resolved with either UD excision alone (n = 8) or 3 months of pelvic floor muscle therapy (PFMT) (n = 8). All 11 with persistent postoperative USUI had video urodynamics (VUDs) confirming Blaivas type 3 USUI. Six patients had a rectus fascial pubovaginal sling (RFPVS) with success in five (83.3%) while five had a mid-urethral obturator tape (MUT-O) with 100% success. Sixteen patients developed de novo stress urinary incontinence (SUI) postoperatively, with resolution after PFMT in 12 (75%). VUDS identified USUI (Blaivas type 3) in two (of the remaining four) patients, managed successfully with MUT-O (n = 1) and RFPVS (n = 1). CONCLUSION: Preoperative USUI is present in 29% with UD. Postoperatively, 35.5% (n = 33) have pre-existing (19) or de novo (14) SUI, of which 60.6% (n = 20) resolves after 12 months of conservative management. Surgery for USUI is required in 13 (13.9%), with cure in 92.3%. This supports our practice to excise UD primarily and delay USUI surgery, therefore, avoiding overtreatment for the majority. SN - 1520-6777 UR - https://www.unboundmedicine.com/medline/citation/31270839/The_incidence_and_outcomes_of_urodynamic_stress_urinary_incontinence_in_female_patients_with_urethral_diverticulum L2 - https://doi.org/10.1002/nau.24090 DB - PRIME DP - Unbound Medicine ER -