You have accessJournal of UrologyUrodynamics/Incontinence/Female Urology: Female Urology I1 Apr 20121554 FEMALE URETHRAL DIVERTICULA EVALUATION OF VOIDING DYSFUNCTION BEFORE AND AFTER SURGERY Ailsa Wilson, Mahreen Hussain, Rizwan Hamid, Jeremy Ockrim, Julian Shah, and Tamsin Greenwell Ailsa WilsonAilsa Wilson London, United Kingdom More articles by this author , Mahreen HussainMahreen Hussain London, United Kingdom More articles by this author , Rizwan HamidRizwan Hamid London, United Kingdom More articles by this author , Jeremy OckrimJeremy Ockrim London, United Kingdom More articles by this author , Julian ShahJulian Shah London, United Kingdom More articles by this author , and Tamsin GreenwellTamsin Greenwell London, United Kingdom More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1324AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The risk of stress urinary incontinence after surgery for female urethral diverticula has lead some centres to routinely perform concomitant anti-incontinence procedures at the time of diverticulectomy. Other disturbances of bladder and voiding function are not widely reported. We aimed to establish the rate and risk factors for pre and postoperative voiding dysfunction in urethral diverticula. METHODS A single institutional review of females who underwent excision of benign urethral diverticula from 2000-2011. RESULTS 42 female patients were examined. Median follow up was 18 months (range 4 to 96 months). Most common was a horseshoe configuration (67%); 22% had circumferential and 11% a simple diverticulum. Size as measured on MRI varied up to a greatest dimension of 40 mm. Three (7%) were recurrent diverticula. Most procedures incorporated use of a Martius fat pad. Surgical morbidity was low. 75% reported preoperative voiding symptoms, equally distributed between stress incontinence, urgency and obstructive symptoms. There was some correlation with preoperative urodynamic abnormalities (stress incontinence, detrusor overactivity or obstructive voiding), which were also present in 75% of cases. In initial postoperative months half of all patients remained asymptomatic or had resolution of their preoperative symptoms. 35% had persistent symptoms. 20% who had not had symptoms before surgery developed new symptoms. Urgency was the commonest new symptom postoperatively - most resolved with time and anticholinergics, and intervention (sacral neuromodulation) required in only one case. Of those with stress incontinence post surgery two thirds had pre-existing stress incontinence. One third were de novo – half of these resolved with conservative measures within six months, and half underwent a subsequent antiincontinence procedure. Two patients developed new obstructive symptoms after surgery, with one requiring a single urethral dilatation. Although numbers were too few for detailed analysis there was a trend for a relationship of risk of pre and postoperative urinary symptoms with increased size and complexity (multiple diverticulae or ostia, circumferential, horseshoe). CONCLUSIONS The complex relationship between the presence of a urethral diverticulum and voiding symptoms makes it difficult to predict postoperative urinary outcomes. Most often de novo urgency and stress incontinence after repair is mild and will spontaneously resolve. Few require a subsequent antiincontinence procedure and as such argues against performing a combined operation. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e630 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ailsa Wilson London, United Kingdom More articles by this author Mahreen Hussain London, United Kingdom More articles by this author Rizwan Hamid London, United Kingdom More articles by this author Jeremy Ockrim London, United Kingdom More articles by this author Julian Shah London, United Kingdom More articles by this author Tamsin Greenwell London, United Kingdom More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...