While urethral diverticulum (UD) affects less than 20 per 1,000,000 women overall, it is thought to represent 1.4% of women with incontinence presenting to urology practices. It is hypothesized to evolve from periurethral glands that become obstructed, infected, and dilated over time, and patients typically present with dyspareunia, bothersome lower urinary tract symptoms (LUTS), and/or recurrent UTIs. In many patients, a periurethral mass can be appreciated on exam. In recent years, magnetic resonance imaging (MRI) has become the imaging test of choice for diagnosis of UD, but ultrasound (US) is a readily available alternative and provides good specificity at a lower cost. Surgical excision of the diverticulum with tension-free, water-tight, three-layer closure continues to be the mainstay of treatment of UD with most studies reporting cure rates of >90%. Concomitant treatment of preexisting stress incontinence with autologous fascial pubovaginal sling can be used at the time of diverticulectomy to avoid a secondary procedure. However, since secondary anti-incontinence procedures are needed in only a small number of patients, up-front stress incontinence treatment may result in significant overtreatment, and staged anti-incontinence procedures continue to be a reasonable option for patients with persistent bothersome stress urinary incontinence (SUI) after diverticulectomy.

Objective To evaluate the efficacy of oral Cyclosporine A (CyA) in treatment of refractory interstitial cystitis/bladder pain syndrome (IC/BPS) and assess safety using drug level and renal function monitoring. Methods Patients with IC/BPS who failed at least 2 prior treatments were enrolled in an open-label study of oral CyA. Medication was started at 3 mg/kg divided twice daily for 3 months. Dose was adjusted based on side effects and drug level measured 2 hours after the morning dose (C2). Primary end point was marked or moderate improvement of global response assessment (GRA) or >50% improvement on the Interstitial Cystitis Symptom Index (ICSI) or Interstitial Cystitis Problem Index (ICPI) at 3 months. Results Twenty-two of 26 patients completed 3-month follow-up; 18 completed the post-study evaluation. Median symptom duration was 66 months (12–336). At 3 months 31%(8/26) improved by GRA, 15%(4/26) had >50% improvement in ICSI, 19% (5/26) in ICPI. Hunner’s lesions (HL) predicted improvement in ICSI (OR=15.4; 95%CI:1.7–224.6, p=0.01) with 75%(3/4) of responders having HL. Two patients withdrew due to hypertension or elevated serum glucose. Mean nuclear glomerular filtration rate declined at 3 months (98.9±31.6 vs. 84.2±25.5 ml/min/1.73m2, p=0.01) and reversed to baseline after treatment discontinuation. C2 levels did not correlate with symptoms but allowed dose reduction in 11 patients. Conclusions Per AUA guidelines Cyclosporine A can be effective in a proportion of patients with refractory IC/BPS. Patients with HL are more likely to benefit. Monitoring of C2 rather than trough levels, can lead to dose reduction thereby minimizing toxicity.

Objective Clean intermittent catheterization (CIC) is a preferred method of bladder management for many patients with spinal cord injury (SCI), but long‐term adherence is low. The aim of this study is to identify factors associated with low urinary quality of life (QoL) in SCI adults performing CIC. Methods Over 1.5 years, 1479 adults with SCI were prospectively enrolled through the Neurogenic Bladder Research Group registry, and 753 on CIC with no prior surgeries were included. Injury characteristics, complications, hand function, and Neurogenic Bladder Symptom Score (NBSS) were analyzed. The NBSS QoL question (overall satisfaction with urinary function) was dichotomized to generate comparative groups (dissatisfied vs neutral/satisfied). Results The cohort was 32.9% female with a median age of 43.2 (18‐86) years, time since the injury of 9.8 (0‐48.2) years, and 69.0% had an injury at T1 or below. Overall 36.1% were dissatisfied with urinary QoL. On multivariable analysis, female gender (odds ratio [OR], 1.63; 95% confidence interval [CI], 1.15‐2.31; P = 0.016), earlier injury (OR, 0.95 per year; 95% CI, 0.93‐0.97; P < 0.001), ≥4 urinary tract infections (UTIs) per year (OR, 2.36; 95% CI, 1.47‐3.81; P = 0.001), and severe bowel dysfunction (OR, 1.42; 95% CI, 1.02‐1.98; P = 0.035) predicted dissatisfaction. Level of injury, fine motor hand function, and caregiver dependence for CIC were not associated with dissatisfaction. Conclusions In a mature SCI cohort, physical disability does not predict dissatisfaction with urinary QoL but severe bowel dysfunction and recurrent UTIs have a significant negative impact. With time the rates of dissatisfaction decline but women continue to be highly dissatisfied on CIC and may benefit from early intervention to minimize the burden of CIC on urinary QoL.

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Patients presenting with new or worsening urgency urinary incontinence after sling placement were more likely to undergo delayed revision compared to those presenting with obstructive voiding symptoms. There is a high rate of bothersome persistent and de novo urgency incontinence after sling revision. Patient expectations should be managed accordingly before sling revision.