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Merriman AL, Peterkin VC, Myers EM, Kennelly M. Patients' Perspectives: Outcomes of Modified Marsupialization for Treatment of Female Urethral Diverticula. UROGYNECOLOGY (PHILADELPHIA, PA.) 2023; 29:452-457. [PMID: 36730945 DOI: 10.1097/spv.0000000000001278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
| | | | - Erinn M Myers
- From the Division of Urogynecology and Pelvic Surgery
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Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy. Int Neurourol J 2021; 25:202-209. [PMID: 34610713 PMCID: PMC8497727 DOI: 10.5213/inj.2142006.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 03/22/2021] [Indexed: 11/08/2022] Open
Abstract
Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.
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Wu B, Bai S, Yao Z, Zhu X, Jiang Y, Li J. Transurethral endoscopic extensive incision of complex urethral diverticula in symptomatic women: case series in a single center experience with long-term follow-up. Int Urol Nephrol 2021; 53:1279-1287. [PMID: 33598843 DOI: 10.1007/s11255-021-02808-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/08/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Urethral diverticula (UD) affect 1-6% of adult women. Complex UD are rare, but can be challenging to manage. To evaluate the efficacy and safety of transurethral endoscopic extensive incision of complex UD in symptomatic women. MATERIALS AND METHODS We retrospectively evaluated 22 female patients with complex UD who underwent transurethral endoscopic extensive incision management in our hospital. This technique was completed by one experienced surgeon over a 7-year period between August 2012 and July 2019. The surgical technique involved placing the patient in a lithotomy position, inserting the needle electrode endoscopically, and incising the tented roof of the UD from its orifice until the entire roof had been opened widely. Outcome data included complete symptom resolution rate, imaging data, de novo stress urinary incontinence (SUI), recurrence, short-term and long-term complications. Cure was defined as decreased UD volume on postoperative magnetic resonance imaging and no post-voiding urinary retention in the diverticular cavity, with symptom resolution. RESULTS The initial symptom-resolution rate after 37.0 (27.0, 50.0) months' follow-up was 81.80% (18/22) and the de novo SUI rate was 13.60% (3/22). No patients required additional operations after conservative therapy. There was no symptomatic or imaging recurrence, and no short-term complications. CONCLUSION Transurethral endoscopic extensive incision was an effective and safe treatment for symptomatic female complex UD. Its symptom-resolution rate and de novo SUI rate might be superior to the conventional transvaginal approach. Moreover, it was less invasive and easier to conduct, with fewer complications.
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Affiliation(s)
- Bin Wu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Song Bai
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Zichuan Yao
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Xianqing Zhu
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Yunzhong Jiang
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China
| | - Jia Li
- Department of Urology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Shenyang, Liaoning, 110004, People's Republic of China.
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Lask A, Rappaport YH, Neheman A, Zisman A, Beberashvili I, Stav K. Transvaginal surgical repair of large urethral diverticula with bipedicle double-opposing flaps of the periurethral fascia. Int Urogynecol J 2020; 32:2969-2973. [PMID: 32797263 DOI: 10.1007/s00192-020-04486-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 07/30/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this study were to describe a novel technique for transvaginal repair of large (> 4 cm) female urethral diverticulum (UD) using bipedicle double-opposing flaps of the periurethral fascia and to evaluate long-term follow-up. METHODS The medical records of 29 women who underwent transvaginal excision of UD at our institution were reviewed retrospectively. Seventeen cases with UD > 4 cm were included in the study. Cystourethroscopy was performed at the beginning of the surgery, and in 60% of cases the orifice of the diverticulum was identified. An inverted-U incision was performed at the vaginal anterior wall. The periurethral fascia was incised longitudinal at the midline and parallel to the urethra. The diverticular sac was dissected and resected. The neck of the diverticulum was closed with 4/0 vicryl suture. The periurethral fascia was sutured using bipedicle double-opposing flaps with interrupted 3/0 vircyl suture. The vaginal mucosa was sutured with 2/0 vicryl continuous suture. RESULTS All 17 women with large UD were operated on using bipedicle double-opposing flaps of the periurethral fascia. Follow-up of 5 ± 2.4 years yielded no recurrence and no other late complications. CONCLUSION Using bipedicle double-opposing flaps of the periurethral fascia during transvaginal excision of large UD is safe and effective.
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Affiliation(s)
- Avigal Lask
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Yishai Hode Rappaport
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amos Neheman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amnon Zisman
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilia Beberashvili
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology, Shamir Medical Center (Assaf Harofeh Campus), Zerifin, 7030000, Israel
| | - Kobi Stav
- Department of Urology, Shamir Medical Center (Assaf Harofeh Campus), 7030000, Zerifin, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Malde S, Sihra N, Naaseri S, Spilotros M, Solomon E, Pakzad M, Hamid R, Ockrim JL, Greenwell TJ. Urethral diverticulectomy with Martius labial fat pad interposition improves symptom resolution and reduces recurrence. BJU Int 2016; 119:158-163. [PMID: 27409723 DOI: 10.1111/bju.13579] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the presenting features and medium-term symptomatic outcomes in women having excision of urethral diverticulum with Martius labial fat pad (MLFP) interposition. PATIENTS AND METHODS We reviewed our prospective database of all female patients having excision of a symptomatic urethral diverticulum between 2007 and 2015. Data on demographics, presenting symptoms and clinical features were collected, as well as postoperative outcomes. RESULTS In all, 70 women with a mean (range) age of 46.5 (24-77) years underwent excision of urethral diverticulum with MLFP interposition. The commonest presenting symptoms were a urethral mass (69%), urethral pain (61%), and dysuria (57%). Pre-existing stress urinary incontinence (SUI) was present in 41% (29) of the women. After surgery, at a mean (SD) of 18.9 (16.4) months follow-up (median 14 months), complete excision of urethral diverticulum was achieved in all the women, with resolution of urethral mass, dysuria and dyspareunia in all, and urethral pain in 81%. Immediately after surgery, 10 (24%) patients reported de novo SUI, which resolved with time and pelvic floor muscle training such that at 12 months only five (12%) reported continued SUI. There was one symptomatic diverticulum recurrence (1.4%). CONCLUSIONS The commonest presenting symptom of a female urethral diverticulum is urethral pain followed by dysuria and dyspareunia. Surgical excision with MLFP interposition results in complete resolution of symptoms in most women. The incidence of persistent de novo SUI in an expert high-volume centre is 12%.
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Affiliation(s)
- Sachin Malde
- Department of Urology, University College London Hospital, London, UK
| | - Néha Sihra
- Department of Urology, University College London Hospital, London, UK
| | - Sahar Naaseri
- Department of Radiology, University College London Hospital, London, UK
| | - Marco Spilotros
- Department of Urology, University College London Hospital, London, UK
| | - Eskinder Solomon
- Department of Urology, University College London Hospital, London, UK
| | - Mahreen Pakzad
- Department of Urology, University College London Hospital, London, UK
| | - Rizwan Hamid
- Department of Urology, University College London Hospital, London, UK
| | - Jeremy L Ockrim
- Department of Urology, University College London Hospital, London, UK
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Bodner-Adler B, Halpern K, Hanzal E. Surgical management of urethral diverticula in women: a systematic review. Int Urogynecol J 2015; 27:993-1001. [PMID: 26564222 DOI: 10.1007/s00192-015-2862-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 09/28/2015] [Indexed: 11/30/2022]
Abstract
Urethral diverticula (UD) are pouch-like outgrowths of the urethral lumen and surgery is by far the most common approach in symptomatic patients. The aim of this systematic review was to evaluate surgical techniques and outcomes in adult women with urethral diverticula. Our secondary objective was to determine the types of study designs. A systematic review of the literature was conducted. Medline, Cinahl and Embase were used as data sources. One hundred and eight studies, including 1,947 patients, remained for final analysis. We summarised 40 single case reports and 68 case series. Overall, transvaginal resection of the UD ± reconstruction was performed in the majority of patients (84 %), followed by marsupialisation (3.8 %) and transurethral endoscopic unroofing (2.0 %). Various other surgical techniques were reported in 181 out of 1,858 cases (9.7 %). Nineteen studies, dealing with 584 patients in all, evaluated a combination of vaginal diverticulectomy with an additional surgical procedure. Fifty-six out of 108 studies (52 %) documented the resolution of symptoms, describing 717 out of 1,044 patients in all being completely symptom-free after surgery. Only 50 out of 108 studies (46.2 %) provided detailed information on the length of follow-up, but showed a poor reporting standard regarding prognosis. Complications were studied only selectively. Because of the inconsistency of these data, it was impossible to analyse them collectively. There were no comparative studies on the different types of surgery in women with urethral diverticula. Overall, the non-comparative nature of the current evidence on the surgical management of UD does not allow any accurate estimation of success and complication rates.
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Affiliation(s)
- Barbara Bodner-Adler
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Ksenia Halpern
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Engelbert Hanzal
- Department of General Gynaecology and Gynaecologic Oncology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Affiliation(s)
- Rosemary Archer
- Department of Obstetrics and Gynaecology; Torbay Hospital; Torquay Devon TQ2 7AA UK
| | - Jennifer Blackman
- Department of Obstetrics and Gynaecology; Torbay Hospital; Torquay Devon TQ2 7AA UK
| | - Mark Stott
- Department of Urology; Royal Devon and Exeter Hospital; Exeter Devon EX2 5DW UK
| | - Julian Barrington
- Department of Obstetrics and Gynaecology; Torbay Hospital; Torquay Devon TQ2 7AA UK
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Giannitsas K, Athanasopoulos A. Female urethral diverticula: from pathogenesis to management. An update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Incidence of female urethral diverticulum: a population-based analysis and literature review. Int Urogynecol J 2013; 25:73-9. [PMID: 23857063 DOI: 10.1007/s00192-013-2155-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Accepted: 06/05/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethral diverticulum (UD) is a protrusion of the urethra through the periurethral fascia. We aimed to determine the population-based incidence of female UD. METHODS Using the records-linkage system of the Rochester Epidemiology Project (REP), we identified women 18 years and older with a new diagnosis of UD in Olmsted County, Minnesota, USA, from 1 January 1980, through 31 December 2011. We also identified cases meeting the same criteria diagnosed at Mayo Clinic, regardless of county of residency. Incidence rates were calculated and trends for changes in incidence over time were tested. We conducted a systematic search of the MEDLINE, EMBASE, Cochrane Systematic Reviews, CENTRAL, Web of Science, and Scopus databases from inception through 30 March 2013, to identify published reports of UD incidence or prevalence. RESULTS We identified 164 incidence cases, including 26 women residing in Olmsted County. Age-adjusted annual incidence of UD in Olmsted County was 17.9 per 1,000,000 women (<0.02 %) per year (95 % CI, 10.9-24.9). We observed a trend toward increased incidence during the past 3 decades (P = 0.03). In our literature review, only 7 studies included an estimate of incidence or prevalence of UD; these estimates ranged from 6.4 per 1,000,000 per year (<0.01 %) having surgical intervention related to UD to a 4.7 % rate of UD diagnosed in asymptomatic women admitted for gynecological or obstetric issues. CONCLUSIONS In this population-based study, female UD was a rare disease, affecting fewer than 20 per 1,000,000 women (<0.02 %) per year.
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Abstract
Female urethral diverticulum is a disorder that affects 1% to 6% of women. Women with diverticula may present with a variety of nonspecific genitourinary complaints, making the diagnosis challenging. Diagnosis is made by physical examination and can be confirmed with cystourethroscopy and/or radiographic imaging. Asymptomatic women can be managed conservatively, whereas treatment for symptomatic women usually involves a diverticulectomy. Potential complications from diverticulectomy include diverticulum recurrence, de novo stress incontinence, urethrovaginal fistula, urethral stricture, and recurrent urinary tract infections. This article reviews the etiology, differential diagnoses, evaluation, and management of female urethral diverticula.
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Tsivian M, Tsivian A, Shreiber L, Sidi AA, Koren R. Female urethral diverticulum: a pathological insight. Int Urogynecol J 2009; 20:957-60. [DOI: 10.1007/s00192-009-0874-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2009] [Accepted: 03/20/2009] [Indexed: 11/29/2022]
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Han DH, Jeong YS, Choo MS, Lee KS. Outcomes of Surgery of Female Urethral Diverticula Classified Using Magnetic Resonance Imaging. Eur Urol 2007; 51:1664-70. [PMID: 17335961 DOI: 10.1016/j.eururo.2007.01.103] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 01/22/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVES We evaluated the surgical outcomes of transvaginal diverticulectomies classified using magnetic resonance imaging (MRI). METHODS We evaluated 30 women (mean age: 46.4 yr; range: 31-73 yr) who were followed up for at least 12 mo after urethral diverticulectomies (mean follow-up: 29 mo; range: 12-93 mo). Characteristics of urethral diverticula were confirmed before surgery by MRI. Diverticula were classified as simple, U-shaped, or circumferential according to MRI features. Transvaginal excisions of urethral diverticula were performed using vaginal flaps and three-layer closures. Cure was defined as the absence of a diverticulum and symptoms. RESULTS Seventeen cases (57%) had simple diverticula, three (10%) had U-shaped diverticula, and 10 (33%) had circumferential diverticula. After the first operation, 23 cases (77%) were cured. None of the simple diverticula recurred, but 33% of the U-shaped and 60% of the circumferential diverticula did recur. Of the seven recurrent cases, three did not require a second operation because their symptoms resolved. Of the four cases that underwent a second operation, three were cured and one was cured after two additional operations. The success rate for circumferential diverticula after initial diverticulectomies was less than that of simple or U-shaped diverticula (p<0.05). Location, size, and multiplicity of urethral diverticula did not affect the surgical outcome (p>0.05). CONCLUSIONS Transvaginal diverticulectomy is effective for treatment of female urethral diverticula. For circumferential urethral diverticula, however, surgical procedures should be adapted to achieve complete resections of the diverticulum.
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Affiliation(s)
- Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Gera PK, Matthews K, Smith G. Urethral diverticulum in a female child. J Pediatr Urol 2007; 3:148-50. [PMID: 18947722 DOI: 10.1016/j.jpurol.2006.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 04/19/2006] [Indexed: 11/18/2022]
Abstract
A urethral diverticulum in a female arises from the wall of the urethra and consists mainly of fibrous tissue lined with epithelium. It is uncommon, and usually presents between decades 3 and 5. Most patients present with non-specific, refractory, lower urinary tract symptoms, unrelated to the diverticulum size or number. The diverticulum may also present as a mass at the introitus. We report a case of urethral diverticulum in a female child that presented as an introital mass.
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Affiliation(s)
- Parshotam K Gera
- Department of Urology, The Children Hospital at Westmead, Locked bag 4001, NSW 2145, Sydney, Australia.
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Ramírez Backhaus M, Trassierra Villa M, Broseta Rico E, Gimeno Argente V, Arlandis Guzmán S, Alonso Gorrea M, Jiménez Cruz J. Divertículos uretrales. Revisión de nuestra casuística y de la literatura. Actas Urol Esp 2007; 31:863-71. [DOI: 10.1016/s0210-4806(07)73741-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Ljungqvist L, Peeker R, Fall M. Female Urethral Diverticulum: 26-Year Followup of a Large Series. J Urol 2007; 177:219-24; discussion 224. [PMID: 17162049 DOI: 10.1016/j.juro.2006.08.064] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Female urethral diverticulum is an acquired condition associated with distressing and chronic symptoms. Surgery sometimes represents a technical challenge and various complications may follow treatment. We present the results of a retrospective analysis in a large personal series operated on during a 26-year period. MATERIALS AND METHODS A total of 68 women underwent surgery. The medical records of all women were reviewed and a followup telephone interview was conducted by an investigator not involved in the care of the patients. There were 64 women available for the interview who were questioned using a standard questionnaire. RESULTS In the majority of patients the postoperative course was uneventful and no complications were encountered. However, a relative stricture of the urethra developed in 1 woman and fistulas developed in 4. In 1 patient the fistula was small and distal, and was left without further surgery. Although diverticulum recurred in 11 patients and urinary incontinence of varying degrees was rather common, as was dyspareunia, 59 patients (92%) would still recommend surgery to a friend having symptoms of the severity they had experienced themselves. CONCLUSIONS Residual symptoms were surprisingly common in the long term. However, most of them were tolerable and it is noteworthy that almost all patients found the operation quite worthwhile when looking back to their preoperative situation. It was evident that repeated surgery frequently resulted in various sequela. The first operation is the golden opportunity for long-term success and a lesson to be learned is that operations for female urethral diverticulum would preferably be centralized to a limited number of surgeons.
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Affiliation(s)
- Lena Ljungqvist
- Department of Urology, Sahlgrenska University Hospital, Sweden
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16
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Abstract
Urethral diverticula are frequently under-diagnosed. The pathogenesis of this condition is poorly understood, and these lesions represent a spectrum of disorders ranging from isolated suburethral cysts to herniation of the urethral lining into the vaginal mucosa. Women with this disorder frequently complain of a host of symptoms referable to the lower urinary and genital tracts. Accurate diagnosis is based on history and clinical evaluation. Perineal ultrasound and MRI are often helpful. Repeated courses of antibiotics and urethral dilatation often fail to resolve the problem, and definitive intervention usually requires surgical excision to provide relief. This chapter describes the current management of this condition, and it heralds a re-look at the patho-aetiology in view of recent MRI findings of symptomatic non-communicating microcystic lesions.
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Affiliation(s)
- James W S Lee
- Division of Urogynaecology & Pelvic Floor Reconstruction, Department of Obstetrics & Gynaecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, Singapore 119074.
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17
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Ben Amna M, Hajri M, Moualli SB, Mehrez R, Chebil M, Ayed M. [The female urethral diverticula: apropos of 21 cases]. ANNALES D'UROLOGIE 2002; 36:272-6. [PMID: 12162194 DOI: 10.1016/s0003-4401(02)00104-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Our goal is to study the clinical, radiological and therapeutic particularity of the female urethral diverticula via a retrospective study of 21 cases. PATIENT AND METHODS Twenty one females, with a mean age of 37 years (range 15 to 62 years) presenting an urethral diverticula, were treated between 1988 and 2000. Clinical examination made diagnosis in all cases. Cystorethrography shown a direct image of diverticula in 100% of cases and intravenous Pyelography in only 24% of cases. The urethral diverticula was excised via a transvaginal approach in all cases. RESULTS Eighteen patients had favourable immediate outcome. Three patients presented an urethrovaginal fistula treated surgically in one case and by bladder drainage in one case. The last patient refused treatment and she was lost to follow-up. After a median follow-up of 54 months (range 18 to 120) only three patients have some urinary urgency that was treated by anticholinergics. CONCLUSION Female urethral diverticula is a rare disease, the diagnosis is easy and only surgical excision gives good results.
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Affiliation(s)
- M Ben Amna
- Service d'urologie, hôpital Charles Nicolle, Tunis, Tunisie
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18
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Abstract
Urethral diverticula remain problematic from both diagnostic and therapeutic standpoints. Recent developments in pelvic imaging with computed tomography, sensitive ultrasonography, and magnetic resonance imaging have greatly advanced diagnostic acumen and improved the clinician's ability to stage lesions as to location, size, and coexistent pathology. Coupled with improved recognition has come advancements in surgical technique, reflective of improved understanding of urethral anatomy and function. Better use of concomitant procedures, such as pubovaginal sling or soft tissue interposition, has continued a steady trend toward improved surgical outcomes when considering urethral function and urinary continence. This article reviews these mutually complementary trends.
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Affiliation(s)
- R Dmochowski
- North Texas Center for Urinary Control, 1325 Pennsylvania Avenue, Suite 550, Fort Worth, TX 76104, USA.
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Fujikawa K, Matsui Y, Fukuzawa S, Soeda A, Takeuchi H. A case of female large urethral diverticulum treated by electrofulguration. Int J Urol 1999; 6:620-2. [PMID: 10609545 DOI: 10.1046/j.1442-2042.1999.00122.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Female urethral diverticulum is not an uncommon disease. We report a case of female urethral diverticulum which caused severe urethral pain, but for which the diagnosis had not been obtained at many hospitals for many years. Transurethral electrocauterization of the diverticulum was very effective in this case.
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Affiliation(s)
- K Fujikawa
- Department of Urology, Kobe City General Hospital, Japan.
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20
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Affiliation(s)
- WENDY W. LENG
- From the Division of Urology, University of Texas Medical School at Houston, Houston, Texas
| | - EDWARD J. McGUIRE
- From the Division of Urology, University of Texas Medical School at Houston, Houston, Texas
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21
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MANAGEMENT OF FEMALE URETHRAL DIVERTICULA. J Urol 1998. [DOI: 10.1097/00005392-199810000-00022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- R R Dmochowski
- Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California
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Ganabathi K, Leach GE, Zimmern PE, Dmochowski R. Experience with the management of urethral diverticulum in 63 women. J Urol 1994; 152:1445-52. [PMID: 7933181 DOI: 10.1016/s0022-5347(17)32442-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The presentation and management are reviewed of 63 women with urethral diverticulum seen at a single institution in 10 years. Of the women 36 (61.9%) had urinary incontinence as a presenting symptom and 20 (31.7%) had incontinence as the only presenting complaint. Diverticula were suspected in 57 cases (90.5%) based on the presence of a periurethral mass during pelvic examination. Investigations included voiding cystourethrogram, excretory urogram, urodynamic studies and recently transvaginal ultrasound. Voiding cystourethrography adequately demonstrated the diverticulum in 60 of the 63 women (95.2%). Urodynamic studies performed in 58 women revealed abnormal findings in 36 (62%), including genuine stress urinary incontinence in 28 (48.3%). The location/number/size/configuration, communication, continence classification was used to define the characteristics of the diverticula. Seven women either refused operation or had small asymptomatic diverticula not requiring treatment. Transvaginal diverticulectomy was performed using a 3-layer closure in 56 women. Concomitant bladder neck suspension was performed in 27 women with documented stress urinary incontinence and/or urethral hypermobility. With a mean followup of 70 months (range 6 to 136) 48 women (85.7%) were completely relieved of the presenting complaint. Complications of diverticulectomy included 2 small distal recurrent diverticula, 1 urethrovaginal fistula and 6 transient early urinary tract infections. None of the women had urethral stricture or recurrent urinary tract infection. Six women (22.2%) who underwent diverticulectomy and bladder neck suspension, and 3 (10.3%) treated with diverticulectomy alone had minimal urinary incontinence requiring less than 2 pads a day.
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Affiliation(s)
- K Ganabathi
- Kaiser Permanente Medical Center and Urodynamics Laboratory, University of California, Los Angeles
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Urologic Management During Acute Care and Rehabilitation of the Spinal Cord-Injured Patient. Phys Med Rehabil Clin N Am 1993. [DOI: 10.1016/s1047-9651(18)30580-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Leach GE, Sirls LT, Ganabathi K, Zimmern PE. L N S C3: a proposed classification system for female urethral diverticula. Neurourol Urodyn 1993; 12:523-31. [PMID: 8312937 DOI: 10.1002/nau.1930120602] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
No descriptive criteria for the preoperative classification of female urethral diverticula have been proposed. Consequently, alternative therapies and different treatment series are not easily compared. Since 1982 the authors have evaluated 61 women with urethral diverticula and have identified those preoperative factors critical to an organized surgical approach to urethral diverticula. From this experience, a simple, comprehensive classification system for female urethral diverticula is proposed. The classification system is called L/N/S/C3. Each letter of the system represents a different characteristic of urethral diverticula. L = Location, the site of the diverticulum, i.e., distal, mid, or proximal urethra, with or without extension beneath the bladder neck. N = Number, whether single or multiple diverticula are present. S = Size, expressed in centimeters (cm). C3 = Configuration, Communication, and Continence Configuration (C1) describes whether we diverticulum is single, multiloculated, or saddle shaped. Communication (C2) indicates the site of communication with the urethral lumen, i.e., distal, mid, or proximal urethra. Continence (C3) is the presence of genuine stress urinary incontinence. Adhering to this format provides the surgeon a systematic means of approaching a urethral diverticulum and thus may minimize postoperative complications. Finally, the authors encourage other surgeons reporting series of urethral diverticula to adopt this system so that standard terminology may allow accurate comparison of surgical results.
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Affiliation(s)
- G E Leach
- Department of Urology, Kaiser Permanente Medical Center, Los Angeles, California 90027
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Surgical treatment of urethral diverticula in females with focus on transurethral techniques. Int Urogynecol J 1991. [DOI: 10.1007/bf00376576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Miskowiak J, Honnens de Lichtenberg M. Transurethral incision of urethral diverticulum in the female. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 1989; 23:235-7. [PMID: 2508214 DOI: 10.3109/00365598909180849] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
A new technique of transurethral incision of urethral diverticulum was successfully used in two women. The method described is safe, simple and shortens operating time.
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Affiliation(s)
- J Miskowiak
- Department of Urology, Bispebjerg Hospital, University of Copenhagen, Denmark
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Bianchi G, Malossini G, Cavalleri S, Curti P, Comunale L, Novella G, Mobilio G. I Diverticoli Dell'Uretra Femminile. Urologia 1988. [DOI: 10.1177/039156038805500603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | | | - G. Mobilio
- Università degli Studi di Verona, Cattedra e Divisione di Urologia - Direttore:
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Abstract
We report a rare case of a diverticulum located along and draining into the roof of the urethra in a woman. This diverticulum was managed successfully endoscopically with a pediatric resectoscope. The pathophysiology of this unusual lesion is discussed, as is the rationale for endoscopic management.
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Abstract
A technique is described which may be utilized to advantage in the treatment of large urethral diverticula. The hazards of extensive subtrigonal dissection are alleviated by leaving a portion of the diverticular floor intact and marsupializing it to the vaginal mucosa.
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Abstract
In essence, incontinence in the elderly should be managed by careful elucidation of the underlying causes and specific treatment aimed at those problems that are remediable. When specific treatment fails, external collecting devices may be helpful. Indwelling catheters should be either temporary, intermittently used, or a last resort. Finally, elderly patients with incontinence should not be treated as pariahs; they require an empathetic and investigative approach to their problem. Continence in the elderly is a goal to be achieved rather than a disease to be treated.
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Abstract
Most urinary tract infections begin as a cystitis secondary to decreased host resistance brought on by disruption of tissue integrity or a decrease in blood supply to the bladder. In the female, infrequent voiding and the uninhibited bladder are the most common causes of urinary tract infection and are best treated by healthy voiding regimens; while in the male, structural and functional obstructive uropathy are most often associated with urinary tract infection and are alleviated by lowering the high intravesical pressures via surgical or medical measures. The concept that host resistance is the determinant of infection rather than the organism has permitted the use of clean, intermittent self-catheterization; clean intermittent self-dilatation; and transurethral diverticulectomy in the therapy of a host of urologic disease syndromes.
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