Elsevier

Urology

Volume 105, July 2017, Pages 181-185
Urology

Reconstructive Urology
Surgical Outcomes of Primary and Recurrent Female Urethral Diverticula

https://doi.org/10.1016/j.urology.2017.02.040Get rights and content

Objective

To evaluate the surgical outcomes of female urethral diverticulectomy.

Materials and Methods

We retrospectively analyzed the medical records of 68 patients with symptomatic urethral diverticula (UD) with at least 1 year of follow-up data following transvaginal urethral diverticulectomy conducted by a single surgeon. The presence of UD was confirmed by a preoperative magnetic resonance imaging (MRI). According to MRI findings, the UDs were classified as simple, U-shaped, or circumferential. Cure was defined as the absence of residual diverticulum on a postoperative MRI with a resolution of symptoms.

Results

There were 27 cases (39.7%) of simple, 16 cases (23.5%) of U-shaped, and 25 cases (36.8%) of circumferential diverticula. The initial cure rate for UD was 77.9%. According to configuration, the cure rates for simple, U-shaped, and circumferential diverticula were 100%, 75.0%, and 64.0%, respectively (P = .043). Of the 15 patients with UD recurrence, 4 did not require reoperation because of symptom resolution. Of the 11 cases that underwent a second operation, 8 patients were cured: 7 via a Martius labial fat pad interposition (MLFI) procedure and 1 via simple excision without MLFI. The overall cure rate was 92.6%. The circumferential configuration was an independent factor for a lower cure rate (odds ratio, 7.97; 95% confidence interval, 1.14-55.69).

Conclusion

Transvaginal diverticulectomy is an effective treatment for female UD. The success rate of an initial surgery was significantly lower for UDs with circumferential configurations than for simple or U-shaped UDs. Regardless of the initial configuration, MLFI is a good treatment option for recurrent or persistent diverticula.

Section snippets

Materials and Methods

We retrospectively analyzed the medical records of patients who underwent a urethral diverticulectomy at our center, conducted by a single surgeon from 1995 to 2015. A total of 68 patients who were followed for at least 12 months after surgery were included. This study was approved by the institutional review board at our institution.

At baseline, all of the patients were evaluated based on their medical history, physical examination, urinalysis, and urine culture, as well as cystourethroscopy

Results

Although 18 patients had undergone a prior urethral diverticulectomy at another institution, 50 patients were primary cases. The mean follow-up period was 37.6 (range, 12-180) months. The mean age of the patients who underwent diverticulectomy was 46.4 (range, 31-73) years. The mean symptom duration at the time of presentation was 17.5 months (range, 1 month-12 years). The most common symptoms were dysuria (n = 15, 22.1%) and urine leakage (n = 15, 22.1%), followed by the presence of a vaginal

Discussion

The present study demonstrated that vaginal urethral diverticulectomy is an effective and reliable treatment method for female UDs. This study also confirmed circumferential configuration as the sole independent factor of a lower cure rate. This study was conducted over a longer period of time with more patients, yet the results were consistent with those of our prior study.5

Previous studies have consistently reported highly diverse factors related to UD recurrence. During a study of 122 UD

Conclusion

Transvaginal diverticulectomy is effective for the treatment of female UD. The success rate of an initial surgery was significantly lower for UDs with circumferential configurations than for simple or U-shaped UDs. Regardless of the initial configuration, MLFI is a good treatment option for recurrent or persistent diverticula.

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Financial Disclosure: The authors declare that they have no relevant financial interests.

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