title: Autologous Pubovaginal Sling for the Treatment of Concomitant Female Urethral Diverticula and Stress Urinary Incontinence.
abstract: OBJECTIVE
  To describe our experience with concomitant repair of urethral diverticula and stress urinary incontinence (SUI) with autologous pubovaginal sling (PVS).
  
  
  METHODS
  A retrospective chart review between January 2006 and 2013 identified 38 women undergoing concomitant diverticulectomy and rectus sheath PVS. Patient demographics, presenting symptoms, prior urethral surgery, concomitant procedures, postoperative outcomes, and complications were evaluated.
  
  
  RESULTS
  The mean duration of symptoms was 56.7 months. Eleven patients presented with recurrent diverticula and 5 patients had prior SUI surgery (3 midurethral slings, 1 PVS, and 1 bulking agent). One patient had a prior urethrolysis. All other slings were cut or excised at the time of surgery. All women had demonstrable SUI on cough stress test or urodynamics. The mean follow-up was 12.7 months. All postoperative voiding cystourethrograms were negative for contrast extravasation. One patient required prolonged (>4 weeks) suprapubic tube drainage for urinary retention. Four others required an additional 1 week of suprapubic tube drainage. Eighteen patients (47%) reported mixed urinary symptoms. Of these, 9 had complete resolution, whereas 9 experienced significant improvement. Overall, 97.3% reported resolution of their dysuria, dyspareunia, and pain symptoms and 90% reported complete resolution of their SUI symptoms. There were 2 urethral diverticula recurrences and 2 SUI recurrences. Perioperative complications, including hemorrhage, sling erosion, or urethrovaginal fistulas, were not observed.
  
  
  CONCLUSIONS
  Concomitant PVS placement is a safe and effective treatment option for SUI in patients undergoing urethral diverticulectomy. The risks and benefits should be weighed and management individualized.
authors.affiliation: Department of Urologic, Vanderbilt University Medical Center, Nashville, TN. Electronic address: ekene.enem@gmail.com.
authors.forename: Ekene
authors.initials: E
authors.lastname: Enemchukwu
authors.affiliation: Department of Urologic, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lai
authors.affiliation: Department of Urologic, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: William Stuart
authors.initials: WS
authors.lastname: Reynolds
authors.affiliation: Department of Urologic, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Melissa
authors.initials: M
authors.lastname: Kaufman
authors.affiliation: Department of Urologic, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Roger
authors.initials: R
authors.lastname: Dmochowski
mesh_terms: D000328:Adult; D000368:Aged; D064592:Autografts; D004240:Diverticulum / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D053825:Suburethral Slings; D014522:Urethral Diseases / Q000150:complications / Q000601:surgery*; D014550:Urinary Incontinence, Stress / Q000150:complications / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods