Surgically Corrected Urethral Diverticula: Long-term Voiding Dysfunction and Reoperation Rates

Ingber, Michael; Firoozi, Farzeen; Vasavada, Sandip P.; Ching, Christina B.; Goldman, Howard B.; Moore, Courtenay; Rackley, Raymond R.

doi:10.1016/j.urology.2010.06.004

Cited by 48 publications

(39 citation statements)

References 12 publications

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“…It is associated with diverticular size >3 cm and more proximal location of the diverticulum [13]. Overall, 4-10 % of patients undergo secondary anti-incontinence procedures after diverticulectomy [13,27,42], and it is usually done about 6-8 months after initial surgery [5••, 13, 42]. Success rates for staged autologous fascial sling are near 100 %, but up to a 23 % rate of retention has been reported [5••].…”

Section: Anti-incontinence Proceduresmentioning

confidence: 99%

“…Recurrence rates range from 2 to 16% in recent series and reoperation rates after primary repair are 2-13 % [5••, 16, 27, 34, 37•]. Patients with repeat surgery, multiple or circumferential diverticula, or diverticula that are more proximal are more likely to have a recurrence requiring surgical intervention [27]. While uncommon, early post-operative complications after UD excision include surgical site infection and urinary retention [5••, 13, 27, 38] (Table 1).…”

Section: Anti-incontinence Proceduresmentioning

confidence: 99%

“…Urethral fistula can be a devastating late complication after diverticulectomy, especially if located proximal to the sphincter resulting in incontinence. Up to 6 % of patients may develop a fistula after UD repair [16,27], and it is felt to be associated with infection, overlapping suture lines, tension on the incision, poor mobilization and vascularization of flaps or grafts, multiple …”

Section: Anti-incontinence Proceduresmentioning

confidence: 99%

“…In addition to about 10-33 % rate of de novo SUI, irritative voiding symptoms, such as frequency, urgency, urgency incontinence and pain, are not uncommon-1 to 67 % of patients may report one or more irritative symptoms post-operatively[5••, 13, 16, 27]. Ingber et al demonstrated that 25-54 % of patients complaining of post-operative LUTS were moderately or greatly bothered by these symptoms[27]. These symptoms can be difficult to manage and can lead to poor patient satisfaction.…”

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confidence: 99%

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Female Urethral Diverticulum: Current Diagnosis and Management

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Goldman

2015

Curr Urol Rep

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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.

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Section: Anti-incontinence Proceduresmentioning

confidence: 99%

Section: Anti-incontinence Proceduresmentioning

confidence: 99%

Section: Anti-incontinence Proceduresmentioning

confidence: 99%

mentioning

confidence: 99%

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Female Urethral Diverticulum: Current Diagnosis and Management

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Goldman

2015

Curr Urol Rep

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“…Reoperation rates are reported to be as high as 10.7%, however the 30-day complication rate has not been specifically examined. 5 Given that urethral diverticulectomies are rare, prior studies evaluating outcomes have primarily been small, single-center cohort studies. We sought to examine the patient demographics of individuals undergoing urethral diverticulectomy and to assess perioperative outcomes using a large multi-institutional prospectively collected database.…”

mentioning

confidence: 99%