1190 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA

Abstract

You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Incontinence - Evaluation & Therapy II1 Apr 20121190 OUTCOMES OF TREATMENT OF STRESS URINARY INCONTINENCE ASSOCIATED WITH FEMALE URETHRAL DIVERTICULA Ahmed El-Zawahry, Ross Rames, and Eric Rovner Ahmed El-ZawahryAhmed El-Zawahry Charleston, SC More articles by this author , Ross RamesRoss Rames Charleston, SC More articles by this author , and Eric RovnerEric Rovner Charleston, SC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1435AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Female Urethral diverticula (UD) may present with different symptoms (sx) including stress urinary incontinence (SUI). Surgical repair of SUI may be done concomitantly with urethral diverticulectomy. However, in some patients (pts) with UD, differentiation of SUI from post-void dribbling is difficult. Additionally, some surgeons may be reluctant to repair SUI at the time of transvaginal urethral diverticulectomy (TVUD) due to the additional surgical time required and potential morbidity of anti-incontinence surgery. We assessed surgical outcomes of the concomitant treatment of SUI at the time of TVUD. METHODS Following IRB approval, we identified pts with a concomitant diagnosis of SUI among 34 consecutive pts at Medical University of South Carolina who underwent TVUD between 2004 and 2009. Sx and the diagnosis of SUI were documented before and after surgery using subjective and objective parameters. Martius flap and autologous pubovaginal slings (APVS) were used selectively based on surgeon and pts preference. Postoperatively, all pts were imaged prior to catheter removal with voiding-cystourethrogram (VCUG). Pts were followed per standard office protocol with follow-up visits at a minimum of 1 week, 3 months (mo) and 15 mo postoperatively. Pts were followed selectively and expectantly thereafter. RESULTS There were 22 pts (65%) with UD and concomitant SUI. Mean age was 52 yo (range 35-77). There were 9 Caucasians, 12 African American and 1 Hispanic. Mean follow-up from TVUD was 18 mo (Range 1-71). Seven pts had previous surgery for SUI including bladder neck suspension (2), a pubovaginal sling surgery (1), transobturator mid-urethral sling +/− perirurethral bulking agent (4). 19/22 underwent APVS in addition to TVUD. 18/22 pts had improvement or resolution of SUI. 3/4 pts with postoperative SUI underwent subsequent APVS, One pt developed de-novo SUI following TVUD. Surgery resulted in the improvement or resolution of the majority of preoperative sx including recurrent urinary tract infection (UTI) (68% vs. 9.5%, p=0.00002), dyspareunia (72% vs. 9.5%, p=0.000004), and frequency (41% vs. 9.5%, p= 0.018) (preoperative vs. postoperative). Complications included one pt with urinary retention following APVS requiring sling lysis and one pt with a recurrent UD 18 mo postoperatively. CONCLUSIONS SUI is often associated with female UD. Surgical reconstruction of UD often results in satisfactory control of urinary sx including SUI when both are treated concomitantly. Treatment of SUI with APVS when undergoing TVUD is feasible with satisfactory outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e482 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ahmed El-Zawahry Charleston, SC More articles by this author Ross Rames Charleston, SC More articles by this author Eric Rovner Charleston, SC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...