Urinary symptoms before and after female urethral diverticulectomy--can we predict de novo stress urinary incontinence?
OBJECTIVE
We assessed preoperative and postoperative urinary symptoms, and determined risk factors for de novo stress urinary incontinence after transvaginal urethral diverticulectomy.


METHODS
We reviewed the case records of 25 consecutive women who had transvaginal urethral diverticulectomy. Urinary symptoms were documented before and after surgery with a structured history and examination pro forma. Demographic, clinical and imaging parameters were reviewed to determine any association with preoperative and postoperative symptoms as well as possible risk factors for postoperative stress urinary incontinence.


RESULTS
The most common presenting symptoms were urinary urgency and frequency (60%), and dyspareunia (56%). On physical examination the most common findings were a tender anterior vaginal wall mass (88%) and urethral discharge (40%). At a mean followup of 15.1 +/- 14.9 months (median 12) the rate of urgency-frequency symptoms and dyspareunia decreased significantly from 60% to 16% and from 56% to 8%, respectively. All the patients who had urge incontinence were cured of this symptom after the operation. De novo stress urinary incontinence developed in 4 patients (16%) postoperatively, and it was mild and only necessitated surgical treatment in 1 patient. A diverticulum larger than 30 mm and proximal urethral location were significant factors (p <0.05) for the development of de novo stress urinary incontinence.


CONCLUSIONS
Irritative bladder symptoms are common in woman with urethral diverticulum and usually resolve after surgical excision. Stress urinary incontinence developed immediately after the operation, and had a significant association with a proximal urethral location and ultrasonically measured size greater than 30 mm.
Stav
Kobi
K
Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Australia. stavkobi@yahoo.com.au
Dwyer
Peter L
PL
Rosamilia
Anne
A
Chao
Fay
F
D000328:Adult; D017677:Age Distribution; D000368:Aged; D004240:Diverticulum / Q000175:diagnosis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D011182:Postoperative Care; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000175:diagnosis / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology*; D013520:Urologic Surgical Procedures / Q000009:adverse effects* / Q000379:methods