Pubovaginal Sling for Treatment of Female Stress Urinary Incontinence Complicated by Urethral Diverticulum

Abstract

To evaluate the practicality of combining urethral diverticulectomy with a procedure for stress urinary incontinence, the records of 14 patients who underwent urethrodiverticulectomy during a 3-year period were reviewed. Noteworthy was that 10 patients (71%) had urinary incontinence as the chief complaint, while 8 (57%) had symptoms of stress urinary incontinence and underwent fluoroscopic urodynamic testing and the others had post-void dribbling. Of the latter 8 patients 7 (50%) demonstrated type II or type III stress urinary incontinence and 1 had a normal study. The 7 women then underwent transvaginal diverticulectomy with a concomitant pubovaginal sling. Of the diverticula 4 (57%) were true diverticula and 3 (43%) appeared to be pseudodiverticula or traction diverticula related to a previous urethral suspension.At 3 to 21 months (mean 17) all patients were cured of stress urinary incontinence. One patient exhibited detrusor instability postoperatively, which was ultimately treated with an Ingleman-Sundberg procedure. Postoperatively, 1 diverticulum recurred, for a recurrence rate of 14%. We conclude that the presence of a urethral diverticulum does not compromise successful repair of associated stress urinary incontinence when the pubovaginal sling procedure is used.