You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 20121553 OUTCOMES OF URETHRAL TRANSECTION FOR RECONSTRUCTION OF CIRCUMFERENTIAL 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.2012.02.1323AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Circumferential urethral diverticula (cUD) extending around the urethra represent a particular reconstructive challenge as the repair of such lesions may leave a large gap in the urethra. It is unclear whether such a configuration presents differently or confers a worse prognosis as compared to simple UD (sUD). This unusual configuration has only rarely been reported on in the literature. We present our experience with the clinical findings and reconstruction of these complex UD. METHODS Following IRB approval, a retrospective review of patients who underwent transvaginal urethral diverticulectomy (TVUD) at a single institution from 2004 to 2009 was performed. 9/34 TVUD were circumferential. Repair of these lesions was performed using a previously described technique utilizing complete division of the urethra to access the dorsally located UD, and reconstruction of the urethra with an end-to-end anastomosis. Martius flap and autologous fascial pubovaginal sling (PVS) were performed as needed. Presenting symptoms and post-operative results were reviewed and outcomes assessed based on patient (pt) questionnaires, chart review, and imaging including, VCUG, CT and/or MRI. RESULTS Mean age was 53 yo in the cUD vs. 51 yo in the sUD. Presenting symptoms in the cUD vs. sUD groups included: stress urinary incontinence (SUI) in 8 (89%) vs 14 (56%), urgency was present in 4 (44%) vs. 13 (52%), pelvic pain and/ or dyspareunia in 8 (89%) vs. 15 (60%), recurrent urinary tract infections (UTI) in 6 (67%) vs. 17 (68%) and vaginal mass in 5 (56%) vs. 17 (68%) and tender anterior vaginal wall was present in 6 pts (67%) vs. 12 (48%). These were not statistically significantly different between groups. Three pts presented with dysuria and one pt had bladder outlet obstruction and high post void residuals secondary to previous sling surgery. The incidence of postoperative complications in the 2 groups were similar (p=0.4). PVS was performed in the 8 pts with SUI and Martius flap in 4 in the cUD group. All patients reported subjective improvement of symptoms. Postoperative SUI was noted by history, physical examination or on urodynamics in 0 vs. 5 pts (cUD vs sUD respectively, p=0.085). Recurrent UD was seen in 1 pt in the cUD group. CONCLUSIONS Patients with cUD have a similar presentation and similar prognosis as compared to those with sUD. Surgical reconstruction and removal may be technically demanding at times however results are similar as compared to sUD. Urethral transection and end-to-end anastomosis is a feasible approach in experienced hands and can result in satisfactory clinical outcomes. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e629-e630 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 ...