Management Of Urethral Diverticula Research Articles

Role of urodynamics in management of urethral diverticulum in females

BackgroundFew studies have focused on the urodynamic findings of urethral diverticula (UD). We characterized the symptoms and urodynamic findings in women with UD. MethodsA retrospective review of all women in a single center having surgical treatment for symptomatic UD between May 2004 and September 2014 was done. Lower urinary tract symptoms were evaluated with International Prostate Symptom Score and Overactive Bladder Symptom Score questionnaires. All patients underwent magnetic resonance imaging and videourodynamic study (VUDS) prior to surgery, and postoperative evaluation with VUDS. ResultsA total of 20 female patients were enrolled into the study. 12 (60%) UD patients presented with symptoms of stress urinary incontinence (SUI). However, there were merely 3 (15%) patients diagnosed as urodynamic SUI. 15 (75%) patients exhibited low catheter-free uroflow. Detrusor overactivity was demonstrated in 4 (20%) patients. Bladder outlet obstruction (BOO) was diagnosed in 8 (40%) cases. Postoperative VUDS revealed persistent BOO in 50% of patients with preoperative BOO. Of these, residual diverticulum was noted by VUDS in one patient. ConclusionFor UD patients with urinary incontinence or voiding dysfunction, VUDS is helpful in accurately characterizing these symptoms.

Urethral diverticulum in pregnancy

Abstract Urethral diverticulum is rare in pregnancy. There is no clear guideline on the management of urethral diverticulum in pregnancy, but most cases were managed conservatively. We report a case of urethral diverticulum in a primigravida woman, who presented with anterior vaginal swelling at 14 weeks of gestation. She was managed conservatively and the cyst (approximately 8 cm × 13 cm) was aspirated during the early stage of labor. However her labor did not progress during the second stage, which resulted in an emergency cesarean section. She underwent diverticulectomy at 1 month postpartum because of the recurrence of the swelling and persistent discomfort. We believe that her dystocia may have been caused by factors other than the diverticulum. As previously described in literature, we concluded that, even in pregnant women with a large urethral diverticulum, vaginal delivery can still be considered with prior aspiration during the early stage of labor.

Urinary Symptoms Before and After Female Urethral Diverticulectomy—Can We Predict De Novo Stress Urinary Incontinence?

We assessed preoperative and postoperative urinary symptoms, and determined risk factors for de novo stress urinary incontinence after transvaginal urethral diverticulectomy. We reviewed the case records of 25 consecutive women who had transvaginal urethral diverticulectomy. Urinary symptoms were documented before and after surgery with a structured history and examination pro forma. Demographic, clinical and imaging parameters were reviewed to determine any association with preoperative and postoperative symptoms as well as possible risk factors for postoperative stress urinary incontinence. The most common presenting symptoms were urinary urgency and frequency (60%), and dyspareunia (56%). On physical examination the most common findings were a tender anterior vaginal wall mass (88%) and urethral discharge (40%). At a mean followup of 15.1 +/- 14.9 months (median 12) the rate of urgency-frequency symptoms and dyspareunia decreased significantly from 60% to 16% and from 56% to 8%, respectively. All the patients who had urge incontinence were cured of this symptom after the operation. De novo stress urinary incontinence developed in 4 patients (16%) postoperatively, and it was mild and only necessitated surgical treatment in 1 patient. A diverticulum larger than 30 mm and proximal urethral location were significant factors (p <0.05) for the development of de novo stress urinary incontinence. Irritative bladder symptoms are common in woman with urethral diverticulum and usually resolve after surgical excision. Stress urinary incontinence developed immediately after the operation, and had a significant association with a proximal urethral location and ultrasonically measured size greater than 30 mm.

Urethral Diverticula, Urethro-Vaginal Fistulae, Vesico-Vaginal Fistulae

This review considers the management of urethral diverticula, urethro-vaginal fistulae, and vesico-vaginal fistulae. The aim of this is to provide the reader with an overview of the current management of these pathologies, with reference to pertinent literature.

Experience with the Management of Urethral Diverticulum in 63 Women

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.

Technical aids in investigation and management of urethral diverticula in the female

Three aids in the diagnosis and management of urethral diverticula are described. First, the technique of double-balloon urethrography has been modified. Diluted contrast medium is used to inflate the intravesical and external balloons so that improved delineation of the anatomy of the diverticular pouches is obtained with undiluted contrast medium. Second, for identification and irrigation with antibiotic solution of the nondraining pouches of compound diverticula, an angiographic catheter is placed in the most distal pouch using fluoroscopically guided manipulation, and then this catheter is replaced with a pigtail-shaped nephrostomy drainage catheter. Third, a 7 F Foley catheter balloon is placed in thin-walled and friable diverticular pouches to facilitate dissection.

Role of urodynamics in management of urethral diverticulum in females

This report deals with 10 female patients with urethral diverticula, 8 of whom were also found to have findings of stress incontinence. This association was proved by urodynamic studies. Three patients were seen with incontinence postdiverticulectomy. Seven patients were evaluated prior to diverticulectomy, and of these 5 had anatomic changes of stress urinary incontinence. Those patients in whom the preoperative evaluation considered them to be at risk for development of stress incontinence postdiverticulectomy were treated with a prophylactic urethropexy. Patients so treated were continent and voided well and were probably spared having a postoperative problem with incontinence. The role of urodynamic techniques in the detection of any association between the diverticulum and a possible risk of postdiverticulectomy incontinence, and how to recognize the problem and its correction before it becomes clinically manifest are the stated purposes of this report.

Suburethral Diverticula in the Female

No AccessJournal of Urology1 Apr 1963Suburethral Diverticula in the Female Donald C. Boatwright, and Vincent Moore Donald C. BoatwrightDonald C. Boatwright More articles by this author , and Vincent MooreVincent Moore More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)64599-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail © 1963 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByStav K, Dwyer P, Rosamilia A and Chao F (2018) Urinary Symptoms Before and After Female Urethral Diverticulectomy—Can We Predict De Novo Stress Urinary Incontinence?Journal of Urology, VOL. 180, NO. 5, (2088-2090), Online publication date: 1-Nov-2008.Ganabathi K, Leach G, Zimmern P and Dmochowski R (2018) Experience with the Management of Urethral Diverticulum in 63 WomenJournal of Urology, VOL. 152, NO. 5 Part 1, (1445-1452), Online publication date: 1-Nov-1994.Allen L, Mount J, Cline D and Mertz J (2018) Pelvic Dystocia Secondary to Urethral Diverticulum and Urinary RetentionJournal of Urology, VOL. 102, NO. 4, (451-453), Online publication date: 1-Oct-1969.F. Andersen M (2018) The Incidence of Diverticula in the Female UrethraJournal of Urology, VOL. 98, NO. 1, (96-98), Online publication date: 1-Jul-1967. Volume 89Issue 4April 1963Page: 581-584 Advertisement Copyright & Permissions© 1963 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Donald C. Boatwright More articles by this author Vincent Moore More articles by this author Expand All Advertisement PDF DownloadLoading ...