title: Management of symptomatic urethral diverticula in women: a single-centre experience.
abstract: BACKGROUND
  Urethral diverticula (UDs) affect between 1% and 6% of adult women. A total of 1.4% of women with stress urinary incontinence (SUI) have a UD. Clinically significant diverticula are rare and can be challenging to manage.
  
  
  OBJECTIVE
  To review results of surgery on UDs in a single surgical centre.
  
  
  METHODS
  We retrospectively evaluated a group of 89 patients with symptomatic UDs referred for surgical intervention to one teaching hospital. Data were from two surgeons over an 8-yr period between October 2004 and November 2012. Follow-up period ranged from 3 mo to 20 mo, and all patients were physically reviewed postoperatively in an outpatient setting.
  
  
  METHODS
  The surgical technique involved placing the patient prone, ureteric catheterisation, dissection and removal of the diverticulum, and layered closure. Where a large defect was present following excision, a Martius flap was interposed.
  
  
  METHODS
  Outcome data collected included symptomatic cure, continence, de novo SUI, early versus late complications, and recurrence.
  
  
  CONCLUSIONS
  Early complications included one urinary tract infection and one Martius graft infection, both requiring intravenous antibiotics. Overall, 72% of patients were dry and cured postoperatively; 13 patients had de novo SUI following surgery. Those with bothersome SUI went on to have an autologous sling at 6 mo. All were dry; three (23%) required clean intermittent self-catheterisation. Three patients had a recurrent residual diverticulum (3.4%) following surgery. One chose conservative management. The other two had a redo diverticulectomy performed via a dorsal approach. They have recovered well and are dry. Two (2.2%) diverticula revealed unexpected abnormal pathology. The first was a leiomyoma; the second was a squamous cell carcinoma requiring further surgery.
  
  
  CONCLUSIONS
  The recommended preoperative imaging is postvoid sagittal magnetic resonance imaging and appropriate use of urodynamic assessment at baseline. The 72% dry rate (including a number with preoperative incontinence) is comparable with the literature as is the development of de novo SUI in 15% of patients. There is a small risk of unexpected tumours (2%).
  
  
  RESULTS
  A urethral diverticulum should be excluded as a diagnosis in anyone troubled by symptoms of a swelling of the urethra often associated with discomfort, pain on intercourse, urinary dribbling after passing urine, and/or recurrent urinary infections. In these circumstances patients should seek advice from their doctors and consider referral for a specialist assessment. If the diagnosis is made and the problem is symptomatic, surgery is likely to resolve the problem but should be carried out in a specialist centre with expertise in the management of this condition.
authors.affiliation: The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Felicity A
authors.initials: FA
authors.lastname: Reeves
authors.affiliation: The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Inman
authors.affiliation: The Royal Hallamshire Hospital, Sheffield Teaching Hospitals, Sheffield, UK. Electronic address: c.r.chapple@shef.ac.uk.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Chapple
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004240:Diverticulum / Q000150:complications / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D012189:Retrospective Studies; D014522:Urethral Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000209:etiology; D013520:Urologic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
keywords: Female LUTS; Paraurethral glands; Urethral diverticula; Urethral diverticulectomy; Urinary incontinence