title: Long-term outcomes after the excision of horseshoe urethral diverticulum.
abstract: OBJECTIVE
  The objective was to report our long-term experience with horseshoe urethral diverticulum (HUD) excised using the urethral preservation technique.
  
  
  METHODS
  Following IRB approval, charts of women who underwent HUD excision and had at least 6 months' follow-up were reviewed. HUD was defined as a bilateral posterior diverticulum that extended laterally and anteriorly past 3 and 9 o'clock on the left and right sides respectively. HUD was diagnosed by pre-operative MRI. Success was defined as no evidence of residual diverticulum on post-operative imaging and the reported resolution of diverticulum symptoms.
  
  
  RESULTS
  Between 1998 and 2014, 12 out of 15 women who underwent HUD excision met the inclusion criteria. Mean follow-up was 81 (median: 52, range: 7-163) months. Presenting symptoms included urinary leakage (n = 8), dyspareunia (n = 6), dysuria (n = 6), frequency (n = 5), urgency (n = 5), and vaginal pain (n = 8). Two patients reported having all three symptoms of the historic triad: dysuria, dyspareunia, and post-void dribbling. Three patients had prior urological interventions, including excision of a unilateral diverticulum, a Spence procedure, and a Skene gland incision. Only 1 patient had a recurrent HUD confirmed by MRI 10 years later, which required reoperation. HUD symptoms resolved in the remaining 11 patients, with post-operative imaging showing no evidence of recurrent HUD, and no further therapy was needed. Of 4 women who reported stress urinary incontinence (SUI) pre-operatively, only 2 reported SUI symptoms post-operatively. There were no cases of post-operative urethro-vaginal fistula.
  
  
  CONCLUSIONS
  At a mean follow-up of 6-7 years, excision of HUD with urethral preservation produced long-lasting resolution in the majority of patients.
authors.affiliation: UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9110, USA.
authors.forename: Shreeya
authors.initials: S
authors.lastname: Popat
authors.affiliation: UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX, 75390-9110, USA. Philippe.zimmern@utsouthwestern.edu.
authors.forename: Philippe E
authors.initials: PE
authors.lastname: Zimmern
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004240:Diverticulum / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome; D014522:Urethral Diseases / Q000601:surgery*
keywords: Female urethral diverticulum; Horseshoe diverticulum; Long-term outcome; Surgical repair