Urethral diverticula in women

A Single-center Retrospective Cohort Study Comparing Complex and Simple Female Urethral Diverticulum Classified Based on Magnetic Resonance Imaging Features

OBJECTIVE

To explore a more reasonable classification method for the evaluation and surgical planning for the management of female urethral diverticulum (UD).

METHODS

This retrospective study included 45 female patients who underwent urethral diverticular excision between January 2018 and December 2023. Patient details and magnetic resonance imaging (MRI) data were collected. The diverticula were classified as complex (cUD) if MRI demonstrated >75% circumferential involvement of the urethra on axial imaging. All other UD were classified as simple (sUD). We performed complete diverticulectomy for sUD and partial excision for cUD. The presenting symptoms, physical examination findings, radiologic studies, operative findings, and post-operative results were compared between the complex and simple cohorts.

RESULTS

The mean age was 45.1 years (range: 25-82 years). The cUD and sUD groups contained 25 (56%) and 20 (44%) patients, respectively. Patients with cUD were more likely to demonstrate voiding symptoms (76% vs 40%, P = .031) and post-voiding dribbling (52% vs 15%, P = .013) than patients with sUD. The largest vertical diameters in the cUD and sUD groups were 2.52 ± 0.89 and 1.89 ± 0.89 cm, respectively (P = .061). The post-operative outcomes were similar between the sUD and cUD groups. There was no significant difference in the incidence of post-operative complications between the two groups.

CONCLUSION

Classification based on the angle of the diverticulum encircling the urethra on MRI can be used for the evaluation and surgical planning of female UD. The selection of an appropriate surgical approach is safe and efficacious for treating female UD and may reduce surgery-associated difficulties and complications.

Experience in conversion of symptomatic urethral diverticulum to asymptomatic status through surgery

Symptomatic urethral diverticulum (UD) is a rare disease typically treated with complete surgical resection, which often involves significant trauma and higher postoperative complication rates. This study introduces a surgical concept to convert "Symptomatic" UD into "Asymptomatic" UD. In our study, we retrospectively analyzed 21 symptomatic female UD patients treated at our center between January 2018 and May 2023, collecting baseline demographic and clinical data. All patients underwent diverticulectomy or partial resection and were followed postoperatively. Mean surgery time was 75.67 ± 28.85 min, with an average blood loss of 25.52 ± 10.69 ml. The median hospital stay was 6 days (interquartile range 3.5-7 days), and the median catheterization time was 15 days (interquartile range 14-21 days). According to the Clavien-Dindo classification, most complications were minor (Grade 1 = 2 patients, Grade 2 = 1 patient, above Grade 3a = 1 patient). Pre- and post-operation UDI-6 and QoL questionnaires showed that symptoms involved in Q1-4 all improved after surgery (P < 0.05) and quality of life score also increased (P < 0.05). The "symptom cure rate" reached 76.2%, suggesting that our surgical approach may offer a minimally invasive and effective option for managing UD.

Imaging the Female Urethra: US and MRI in Cystic and Solid Pathologic Conditions

The female urethra can be affected by numerous pathologic conditions, many of which are infrequent and often underdiagnosed, particularly before the introduction of MRI. Diagnosing urethral pathologic conditions is challenging due to ambiguous signs and symptoms, nonspecific physical examinations, atypical presentations (such as benign conditions mimicking malignant disorders), and large lesions. Various imaging techniques, including transperineal or transvaginal US and MRI, are essential for accurate anatomic and tissue characterization. Female urethral pathologic conditions can be categorized into cystic lesions (with urethral diverticulum as the most common), benign and malignant solid urethral lesions, and iatrogenic lesions. Defining the location of the pathologic finding is the first step in radiologic diagnosis. By analyzing tissue characteristics (cystic versus noncystic), shape, morphology, and location (including urethral dependence and relationship to the pubic symphysis), an accurate diagnosis can often be achieved. Identifying whether a lesion is urethral-dependent helps distinguish between urethral and other conditions, such as Bartholin gland and Gartner duct cysts. Radiologists must recognize these features to determine the most appropriate diagnostic and therapeutic strategies. ©RSNA, 2025 Supplemental material is available for this article.

British Association of Urological Surgeons (BAUS) consensus document for the management of benign female urethral lesions

OBJECTIVE

To provide a consensus document for the management of benign female urethral lesions.

METHODS

The British Association of Urological Surgeons (BAUS) Female, Neurological and Urodynamic Urology (FNUU) Section created a consensus document to guide the management of the commonest of urethral swellings using expert consensus with a modified Delphi technique.

RESULTS

Benign urethral lesions in females can include urethral mucosal prolapse, urethral caruncle, Skene's gland cysts and urethral diverticulum. They can present in a variety of ways including haematuria, lower urinary tract symptoms and voiding dysfunction, and can initially be overlooked or not recognised, resulting in delayed management.

CONCLUSION

This consensus statement led by the FNUU Section of the BAUS, in consultation with BAUS members and consultants working in units throughout the UK, aimed to create a comprehensive and pragmatic management pathway for the assessment, investigation and treatment of benign urethral lesions in females.

Ultrasound in Female Urinary Incontinence

Urinary incontinence (UI) is a common health condition that may interfere with the quality of life. A comprehensive evaluation of female UI helps with effective and safe treatments. Ultrasound has gained popularity to explore UI recently because it can collect crucial information for treatment planning and counseling. Translabial and introital approaches are commonly and reliably applied to ultrasound. The images can be obtained using two-dimensional and three-dimensional ultrasounds. Ultrasound is the only modality capable of confirming the presence or absence of a mid-urethral sling (MUS) and is able to demonstrate bulking agents as well. Although some of the ultrasound findings may only be incidental or supplementary to the patient's symptoms, ultrasound benefits for investigating the pathophysiology of UI and surgical outcomes of MUS procedures. It is anticipated that standardization in terminology, measurement techniques, and reporting can be established in the near future.

Peri-Urethral and Anterior Vaginal Wall Masses: Does Radiological Imaging Change the Predicted Diagnosis?

INTRODUCTION

This study aims to determine the accuracy of radiological imaging compared with surgical pathology in patients with periurethral (PU) and anterior vaginal wall (AVW) lesions.

METHODS

This study is a retrospective analysis of 126 women who underwent surgical treatment for PU and AVW masses between 2011 and 2020. Clinicopathological data were extracted along with radiological findings from medical records. The primary outcome was the diagnostic accuracy of preoperative imaging compared to the gold standard, pathological diagnosis. The secondary outcome was the rate of imaging correcting the clinical diagnosis.

RESULTS

A total of 126 women with a median age of 42 underwent surgical treatment for PU and AVW masses. The most diagnoses were periurethral cysts (PUC) (52%) and urethral diverticulum (UD) (39%). Clinical diagnosis was accurate in 102 cases (81%) for the group of pathological diagnoses. Magnetic resonance imaging (MRI) and transvaginal ultrasound (TV US) were performed in 82 (65%) and 22 (17%) cases. The accuracy of MRI and TV US for the diagnosis of PU and AVW lesions was 76% and 82%, respectively. MRI and TV US corrected the clinical diagnosis in five (6%) and two (9%) cases, respectively. Voiding cystourethrography (VCUG) and double balloon urethrography (DBU), each performed in six (5%) cases, were accurate in four (67%) and three (50%) cases. No statistical difference was found for any imaging modality compared to clinical diagnosis.

CONCLUSION

Clinical diagnosis based on pelvic and cystoscopy examinations was sufficient for diagnosing PU and AVW masses and was not significantly different from imaging diagnosis. Imaging may be helpful with preoperative surgical planning in selected cases.

Non-Surgical Management of Chronic Pelvic Pain in Females

PURPOSE OF REVIEW

The purpose of this paper is to review the most recent literature on non-surgical therapeutic options for chronic pelvic pain in females.

RECENT FINDINGS

Chronic pelvic pain can arise from virtually any organ system in the human body. If a precise etiology is identified, the management of chronic pelvic pain can be tailored accordingly. In some cases, patients with chronic pelvic pain can remain without a specific diagnosis. In these circumstances, adequate symptom control can still be achieved even if no underlying disorder is found. Although chronic pelvic pain is often a difficult disorder to manage, several non-surgical management options exist. Employing a multidisciplinary approach, most patients can achieve adequate symptom relief, usually without the need for surgical intervention.

Female urethral diverticulum with large calculus: Presentation and management

Level of evidence: Not applicable for this multicentre audit

Pathophysiology and Management of Long-term Complications After Transvaginal Urethral Diverticulectomy

Female urethral diverticulum (UD) is a rare and benign condition that presents as an epithelium-lined outpouching of the urethra. It has various symptoms, of which incontinence in the form of postmicturition dribble is the most common. The gold standard for the diagnosis of UD is magnetic resonance imaging, and the treatment of choice is transvaginal diverticulectomy. Despite the high success rate of transvaginal diverticulectomy, postoperative complications such as de novo stress urinary incontinence (SUI), recurrence, urethrovaginal fistula, recurrent urinary tract infections, newly-onset urgency, and urethral stricture can occur. De novo SUI is thought to result from weakening of the anatomical support of the urethra and bladder neck or damage to the urethral sphincter mechanism during diverticulectomy. It can be managed conservatively or may require surgical treatment such as a pubovaginal sling, Burch colposuspension, or urethral bulking agent injection. Concomitant SUI can be managed by concurrent or staged anti-incontinence surgery. Recurrent UD may be a newly formed diverticulum or the result of a remnant diverticulum from the previous diverticulectomy. In cases of recurrent UD requiring surgical repair, placing a rectus fascia pubovaginal sling may be an effective method to improve the surgical outcome. Urethrovaginal fistula is a rare, but devastating complication after urethral diverticulectomy; applying a Martius flap during fistula repair may improve the likelihood of a successful result. Malignancies in UD are rarely reported, and anterior pelvic exenteration is the recommended management in such cases.

Current Perspectives on the Diagnosis and Management of Primary Urethral Cancer: A Systematic Review

Primary urethral cancer (PUC) is a rare but highly aggressive malignancy that causes malignant urethral obstruction. We conducted a literature review using PubMed to identify original research studies that assessed the diagnosis and management of primary urethral cancer. PUC affects men more than women, is more common in African Americans than Caucasians, and is associated with history of chronic inflammation and irritation of the urinary tract. Patients suspected of PUC should undergo a complete work-up including cystoscopy, magnetic resonance imaging, and biopsy. In men and women, surgical monotherapy ranging from organ-sparing to more radical reconstructive procedures has adequate survival rates for early stage PUC and has been shown to be similarly as effective as radiation monotherapy, while multimodal therapy has become the standard of treatment for advanced stage PUC. Salvage surgery or radiation therapy has been linked with increased survival rates. Nodal involvement at the time of diagnosis is a negative prognosticator and should be treated with multimodal therapy. Further prospective studies with greater sample sizes and standardized clinical trials would allow for greater consistency in evaluating the different treatment modalities for PUC.

British Association of Urological Surgeons (BAUS) consensus document: Management of female voiding dysfunction

OBJECTIVES

To report the British Association of Urological Surgeon's (BAUS) guidance on the assessment and management of female voiding dysfunction.

METHODS

A contemporary literature search was conducted to identify the evidence base. The BAUS Section of Female, Neurological and Urodynamic Urology (FNUU) Executive Committee formed a guideline development group to draw up and review the recommendations. Where there was no supporting evidence, expert opinion of the BAUS FNUU executive committee, FNUU Section and BAUS members, including urology consultants working in units throughout the UK, was used.

RESULTS

Female patients with voiding dysfunction can present with mixed urinary symptoms or urinary retention in both elective and emergency settings. Voiding dysfunction is caused by a wide range of conditions which can be categorized into bladder outlet obstruction (attributable to functional or anatomical causes) or detrusor underactivity. Guidance on the assessment, investigation and treatment of women with voiding dysfunction and urinary retention, in the absence of a known underlying neurological condition, is provided.

CONCLUSION

Wa have produced a BAUS approved consensus on the management pathway for female voiding dysfunction with the aim to optimize assessment and treatment pathways for patients.

Transurethral endoscopic extensive incision of complex urethral diverticula in symptomatic women: case series in a single center experience with long-term follow-up

BACKGROUND

Urethral diverticula (UD) affect 1-6% of adult women. Complex UD are rare, but can be challenging to manage. To evaluate the efficacy and safety of transurethral endoscopic extensive incision of complex UD in symptomatic women.

MATERIALS AND METHODS

We retrospectively evaluated 22 female patients with complex UD who underwent transurethral endoscopic extensive incision management in our hospital. This technique was completed by one experienced surgeon over a 7-year period between August 2012 and July 2019. The surgical technique involved placing the patient in a lithotomy position, inserting the needle electrode endoscopically, and incising the tented roof of the UD from its orifice until the entire roof had been opened widely. Outcome data included complete symptom resolution rate, imaging data, de novo stress urinary incontinence (SUI), recurrence, short-term and long-term complications. Cure was defined as decreased UD volume on postoperative magnetic resonance imaging and no post-voiding urinary retention in the diverticular cavity, with symptom resolution.

RESULTS

The initial symptom-resolution rate after 37.0 (27.0, 50.0) months' follow-up was 81.80% (18/22) and the de novo SUI rate was 13.60% (3/22). No patients required additional operations after conservative therapy. There was no symptomatic or imaging recurrence, and no short-term complications.

CONCLUSION

Transurethral endoscopic extensive incision was an effective and safe treatment for symptomatic female complex UD. Its symptom-resolution rate and de novo SUI rate might be superior to the conventional transvaginal approach. Moreover, it was less invasive and easier to conduct, with fewer complications.

The Modified Prone Jack-knife Position for the Excision of Female Urethral Diverticula

BACKGROUND

Female urethral diverticula (UD) are an uncommon and often overlooked aetiology in women presenting with lower urinary tract symptoms, urethral pain, and recurrent urinary tract infection. With increasing awareness, appropriate imaging is more commonly undertaken with consideration given to surgical management.

OBJECTIVE

The video presented demonstrates the technique for excising large and/or complex UD using a modified prone jack-knife position-a position that offers excellent surgical access and allows the surgeon to operate in a more ergonomic position.

DESIGN, SETTING, AND PARTICIPANTS

A retrospective review of the data on patients undergoing excision of UD at a tertiary referral unit was performed.

SURGICAL PROCEDURE

Urethral and suprapubic catheters (±insertion of ureteric stents) were placed in supine position. UD excised in the modified prone jack-knife position (±placement of a Martius flap).

MEASUREMENTS

Subjective cure rate, recurrence rate, rates of postoperative urinary incontinence, need for secondary incontinence procedure, and postoperative complications were measured.

RESULTS AND LIMITATIONS

A total of 121 patients were operated on in the study period. The mean follow-up time was 10 mo (range 3-40). The most frequent presenting symptoms included a vaginal mass (n = 76, 63%), followed by dysuria (n = 72, 60%) and pelvic pain (n = 71, 59%). An identifiable aetiological factor was present in 45 patients, including traumatic vaginal delivery (18, 15%), prior periurethral surgery (17, 14%), and urethral dilatation (10, 8%). All patients underwent postvoiding magnetic resonance imaging (MRI) to confirm the diagnosis and plan surgery. UD ranged in maximum diameter from 8 to 48 mm, with a mean of 43 mm (standard deviation 9.24). The most common anatomical location was midurethral (55, 46%), followed by distal (36, 30%), proximal (25, 21%), and full length (5, 4%). Most UDs were single in configuration (74%), followed by multiloculated (15%), saddle shaped (7%), and circumferential (5%). On preoperative videourodynamics, 17 (14%) had stress urinary incontinence. UD excision was undertaken in the modified prone jack-knife position in all cases. A Martius flap was utilised in 36 (30%). The median postoperative postvoiding residual was 26 ml (interquartile range 0-40). In total, 88 (73%) patients were continent postoperatively and 16 (13%) experienced de novo stress urinary incontinence. Of the 37 with pre-existing stress incontinence symptoms, 20 (54%) were continent after operation. A total of 14 patients had subsequent autologous fascial sling at 6 mo. In total, five symptomatic recurrences occurred (4%); of these patients, three elected to undergo surgical excision, all of whom had symptom resolution and were continent after operation. A total of 11 patients (9%) experienced a Clavien-Dindo grade I-II complication within 90 d after operation. Five patients complained of dyspareunia, which resolved by 6 mo.

CONCLUSIONS

The modified prone jack-knife position facilitates excellent access for excision of both simple and complex UDs. This positioning of the patient is not widely recognised amongst urologists. Using this approach, there were low rates of symptomatic recurrence and de novo stress incontinence at medium-term follow-up. Associated urinary incontinence resolves in over half of patients following UD excision; hence, we advocate deferring any incontinence procedure until after the results of surgery are established.

PATIENT SUMMARY

Surgical removal of urethral outpouching (diverticula) in women is challenging due to its potential to damage the nearby sphincter muscle, which controls continence, or the urethra tube. Placement of patients on their front, rather than on their back, provides excellent access for the surgical removal of urethral diverticula. With this approach, we achieved excellent rates of cure and low rates of urinary incontinence at an average follow-up of 10 mo.

Transvaginal management of symptomatic complex urethral diverticula by definite closure of diverticula and robust reconstruction of the urethra

Background

Management of complex urethral diverticula (UDs) is challenging not only for the ostia detection and urethral reconstruction in surgery but also for the high risk of postoperative complications. We aimed to present the experience of surgical management for UDs by transvaginal partial diverticulectomy and urethral reconstruction.

Methods

The database of medical record library was retrospectively searched for patients underwent partial diverticulectomy for symptomatic complex UDs. During the surgical procedure, the cystourethroscopy was firstly performed to locate the diverticular ostium. The surgeon exposed and opened the diverticulum along its maximum axis. The surgeon recorded the location of ostia where saline solution flowed out, when one assistant pressed suprapubic region to increase inner-pressure of bladder and urethra. We focused on definite closure of diverticular ostia and robust urethral reconstruction.

Results

The present study included 39 patients with mean age of 45 years. There were 28 patients, 23 patients and 21 patients suffering from recurrent urinary infection, frequency and urgency. Ten patients had stress urinary incontinence. All of the 39 patients had complex UDs because of U-shaped diverticula (24/39) and circumferential diverticula (15/39). Multiloculated UDs were detected in 17 out of 39 patients. During the median follow-up time of 2.0 (1.0-12.0) years, there was no case of de novo urinary incontinence. However, 2 patients still had mild stress urinary incontinence without additional treatment. At postoperative 3 months, five patients had para-urethral cysts with the size ranging from 0.3 to 0.4 cm, which were absorbed in follow-up.

Conclusions

The method of transvaginal partial diverticulectomy, definite closure of diverticular ostium, and layered reconstruction of the urethra is a feasible surgical alternative for UDs.

Clear cell carcinoma in a urethral diverticulum

A 54-year-old female presented with a long history of multi-drug-resistant urinary tract infections, urinary urgency and frequency, haematuria, stress urinary incontinence and difficulty voiding. Examination revealed a large, hard anterior vaginal wall mass with purulent discharge. Investigation with MRI demonstrated a complex urethral diverticulum containing stones with fistulation into the vagina. Drainage of the abscess and excision biopsy of the diverticulum revealed clear cell carcinoma. She therefore underwent completion urethrectomy, bladder neck closure and Yang-Monti urinary diversion – a positive tumour margin led to resultant cystectomy and ileal conduit.

Risk factors of postoperative sexual function in patients with urethral diverticulum and their partners: A cohort study of 83 women

Introduction and Objective:

Several studies have focused on the treatment and recurrence of urethral diverticulum (UD). However, few investigations have addressed sexual function in patients with UD. Therefore, we sought to examine sexual function in women affected by UD.

Materials and Methods:

There were 108 accepted cases involving transvaginal diverticulectomy at our institution. Ultimately, 83 women were included for further analysis, only 61 of these women had sexual partners. We collected data for the Female Sexual Function Index (FSFI) from the female patients and the Male Sexual Health Questionnaire (MSHQ) from their male partners before and after surgery.

Results:

Preoperatively, the UD size affected the female patient's arousal and lubrication (p=0.04), and the UD location affected their satisfaction. However, no significant between-group differences were found in the total FSFI score. For all women, sexual activity improved after surgery (p=0.0087). In addition to improvements in arousal for women with a large UD, improvements in lubrication were affected by the UD size, number and shape, increases in satisfaction scores were impacted by the UD location and shape, and pain relief was linked to the UD number and shape. Analysis of the MSHQ results revealed no between-group differences among the male partners.

Conclusion:

Only the UD size and location affected sexual function in women with a small UD. Surgery could improve female sexual function but did not affect the sexual function of the patient's partners.

Translabial ultrasound imaging of urethral diverticula

OBJECTIVE

Urethral diverticulum is an uncommon cause of urinary dysfunction in women, with often a significant delay in diagnosis. Urethroscopy and/or magnetic resonance imaging are/is widely used for its identification. Translabial ultrasound is an alternative, particularly since the introduction of three-/four-dimensional imaging. The aim of our study was to review 10 years' experience of urethral diverticula evaluated by translabial ultrasound.

METHODS

We reviewed 4121 patients seen in a tertiary urogynecologic unit between 2008 and 2018. All women were examined using multiplanar translabial ultrasound as well as office urethroscopy. Data regarding demographics, presenting symptoms and findings on clinical examination were collected. Archived ultrasound volumes were analyzed for diverticular location, diameters, complexity and echogenicity as well as tract visualization.

RESULTS

Of our study population, 23 (0.6%) were found to have a major urethral abnormality on translabial ultrasound, 15 of whom were confirmed to have a urethral diverticulum on urethroscopy. Of these, 12 had a cystic component and three were non-cystic on imaging. Mean maximum diameter was 15.3 mm (range, 4-32 mm). In 9/15 there was a simple diverticulum, while in 6/15 it was classified as complex. A communicating tract was seen in 10/15 (67%), and this was located at the 5-7 o'clock position in 7/10 (70%). Mean urethral circumference covered by the diverticulum was 39%.

CONCLUSIONS

Translabial ultrasound is a valid, non-invasive method for the diagnosis of urethral diverticulum. A cystic structure crossing the urethral rhabdosphincter has high predictive value for urethroscopic diagnosis of urethral diverticulum. Multiple hyperechogenic foci may indicate the presence of a small urethral diverticulum. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

Female urethral diverticula: An elusive pathology that can cause significant problems

Female urethral diverticula are a rare pathology, although thought to be under-diagnosed. They can present with a large variety of symptoms, and can be complicated by stones or malignancy. Magnetic resonance imaging is widely accepted to be the best form of imaging for this condition, although voiding cystourethrogram studies are helpful in providing information on bladder function. Symptomatic patients should be treated surgically through urethral diverticulectomy.

Level of evidence: Not applicable for this multicentre audit.

Incidental Finding of Urethral Diverticulum in a Woman with History of Recurrent Urinary Tract Infections

We present an incidental finding and management of a urethral diverticulum containing mixed composition of struvite and ammonium urate stones. Status post sleeve gastrectomy, patient presented to our bariatric clinic with epigastric pain associated with nausea and vomiting. A computed tomography scan was performed to rule out any complications of the procedure in which urethral stones were reported contained within a diverticulum. This finding, in retrospect, correlated with patient's past history of recurrent urinary tract infections. Over all, urethral diverticulum with struvite stones is a rare entity with few reported cases in literature thus a high index of suspicion is needed in patients with related symptoms. Here a case presentation and treatment rationale are described along with a brief review of existing literature.

The treatment of complex female urethral pathology

Lower urinary tract symptoms (LUTS) in women produce significant bother. Common conditions causing LUTS in women include urinary tract infections, overactive bladder, and stress incontinence. Urethral diverticulae and female urethral strictures are rare pathologies. They can cause symptoms, which can mimic commoner conditions, leading to delay in diagnosis and unnecessary delay in treatment. In this article, we discuss in detail the definition, symptoms, epidemiology, pathogenesis, diagnosis, and treatment option for these two conditions. Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.

Preliminary report on the effect of urethral diverticulum magnetic resonance imaging configuration on the incidence of new onset urodynamic stress urinary incontinence following excision

Context:

Excision of urethral diverticulum in females has been reported to be associated with new onset urodynamic stress urinary incontinence (USUI) in up to 49%.

Aims:

We have assessed the incidence of new onset USUI in all patients having urethral diverticulum excision with Martius fat pad interposition under the care of a single surgeon between May 1, 2007, and December 1, 2011. The incidence of new onset USUI has been correlated with the preoperative magnetic resonance imaging (MRI) appearance of the urethral diverticulum.

Patients and Methods:

All 33 patients (mean age 42) having urethral diverticulum with Martius fat pad interposition had prospective data tabulated on demographics, preoperative MRI appearance, and pre- and post-operative videocystometrogram.

Statistical Analysis Used:

Statistical analysis was performed by Chi-squared and Fisher's exact.

Results:

Of the 33 patients, 10 (30%) had preoperative USUI and have been excluded from this study. Other preoperative urodynamic findings included idiopathic detrusor overactivity in ten (30%) and bladder outflow obstruction in five (16%). Two (10%) of the patients had a simple diverticulum, 16 (73%) had a horseshoe diverticulum, and 5 (17%) had a circumferential diverticulum. The rate of new onset USUI was 0% for simple, 6% for saddle, and 20% for circumferential.

Conclusions:

New onset USUI occurs in 9% of patients having excision of urethral diverticulum with Martius fat pad interposition. The incidence appears to increase with increasing complexity of urethral diverticulum on preoperative MRI – rising from 0% following simple urethral diverticulum excision to 20% following circumferential diverticulum excision.

Ultrasonographic Features of Female Urethral Diverticula: A Retrospective Study of 25 Patients

OBJECTIVES

This article summarizes the ultrasonographic features of female urethral diverticula on biplane transrectal ultrasound (B-TRUS).

METHODS

A retrospective study was performed with 25 consecutive women who were diagnosed and treated as having urethral diverticulum (UD) between January 2012 and March 2016. All the patients were preoperatively evaluated using B-TRUS. The number, location, configuration, size, and type of the UD on B-TRUS were assessed.

RESULTS

Twenty-eight diverticula were found on B-TRUS. Twenty-two patients had single diverticulum, whereas the other 3 had double diverticula. The locations included proximal (14%), mid (46%), and distal (40%) urethra. In transverse section, the configuration presented as round or oval (46%), and horseshoe-like or circumferential (54%). The maximal diameter of the 28 diverticula ranged from 3 to 48 mm. The types contained simple UD (36%) and complex UD (64%). Color blood flow signal could be detected in the septa, cystic wall, and solid mass, whereas negative in other areas inside the UD.

CONCLUSIONS

Various sonographic characters of female UD could be observed during the evaluation, including single or multiple diverticula, different sites, diverse shapes, and septa, calculi, or neoplasm inside diverticulum, all of which could be clearly displayed on B-TRUS.

Urethral diverticulectomy with Martius labial fat pad interposition improves symptom resolution and reduces recurrence

OBJECTIVE

To assess the presenting features and medium-term symptomatic outcomes in women having excision of urethral diverticulum with Martius labial fat pad (MLFP) interposition.

PATIENTS AND METHODS

We reviewed our prospective database of all female patients having excision of a symptomatic urethral diverticulum between 2007 and 2015. Data on demographics, presenting symptoms and clinical features were collected, as well as postoperative outcomes.

RESULTS

In all, 70 women with a mean (range) age of 46.5 (24-77) years underwent excision of urethral diverticulum with MLFP interposition. The commonest presenting symptoms were a urethral mass (69%), urethral pain (61%), and dysuria (57%). Pre-existing stress urinary incontinence (SUI) was present in 41% (29) of the women. After surgery, at a mean (SD) of 18.9 (16.4) months follow-up (median 14 months), complete excision of urethral diverticulum was achieved in all the women, with resolution of urethral mass, dysuria and dyspareunia in all, and urethral pain in 81%. Immediately after surgery, 10 (24%) patients reported de novo SUI, which resolved with time and pelvic floor muscle training such that at 12 months only five (12%) reported continued SUI. There was one symptomatic diverticulum recurrence (1.4%).

CONCLUSIONS

The commonest presenting symptom of a female urethral diverticulum is urethral pain followed by dysuria and dyspareunia. Surgical excision with MLFP interposition results in complete resolution of symptoms in most women. The incidence of persistent de novo SUI in an expert high-volume centre is 12%.