title: Simple vs complex urethral diverticulum: presentation and outcomes.
abstract: OBJECTIVE
  To determine whether complex anatomic configurations of urethral diverticula (UD), namely circumferential UD (cUD), present differently or confer a worse prognosis as compared with simple UD (sUD).
  
  
  METHODS
  After institutional review board approval, a retrospective review of patients who underwent transvaginal urethral diverticulectomy at a single institution over an 8-year period was performed. A total of 43 patients were identified, of which 11 were found to have cUD. These lesions were repaired with complete division of the urethra to access the dorsally located portion of the UD, followed by end-to-end anastomosis for urethral reconstruction with a Martius flap and/or autologous fascial pubovaginal sling performed as needed. Presenting symptoms and surgical outcomes were reviewed.
  
  
  RESULTS
  Mean age was 50.9 years in the cUD vs 52.7 years in the sUD. Patients with cUD were more likely to present with stress urinary incontinence than those with sUD (90.9% vs 56.3%; P = .04). There was no statistical difference in the rate of preoperative urgency, pelvic pain and/or dyspareunia, postvoid dribbling, and urinary tract infection. Postoperatively, patients with cUD were more likely to have a urinary tract infection (27% vs 3%; P = .2); otherwise, rates of postoperative results were similar.
  
  
  CONCLUSIONS
  Urethral transection and end-to-end anastomosis for the repair of complex UD is a feasible approach and results in similar clinical outcomes compared with the repair of sUD.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC. Electronic address: nickles@musc.edu.
authors.forename: Samuel Walker
authors.initials: SW
authors.lastname: Nickles
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Gini
authors.initials: G
authors.lastname: Ikwuezunma
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Lara
authors.initials: L
authors.lastname: MacLachlan
authors.affiliation: Division of Urology, Department of Surgery, Southern Illinois University, Carbondale, IL.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Zawahry
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Ross
authors.initials: R
authors.lastname: Rames
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Eric
authors.initials: E
authors.lastname: Rovner
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D015331:Cohort Studies; D004240:Diverticulum / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000175:diagnosis* / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods