title: Female Urethral Diverticula in the Contemporary Era: Is the Classic Triad of the "3Ds" Still Relevant?
abstract: OBJECTIVE
  To evaluate the correlation between signs and symptoms of urethral diverticulum (UD), especially the classic triad of 3Ds including dysuria, dyspareunia, and postvoid dribbling, before and after transvaginal urethral diverticulectomy, in relation to anatomic configuration on imaging.
  
  
  METHODS
  After IRB approval, records of 54 females who underwent transvaginal urethral diverticulectomy were retrospectively reviewed. Urinary symptoms before and after the procedure were correlated with the anatomical configuration of the UD on magnetic resonance imaging.
  
  
  RESULTS
  The median age of the patients was 52 years (range 29-77). Common presenting symptoms were stress urinary incontinence (60%), dyspareunia (60%), and recurrent urinary tract infections (70%). The classic 3Ds were present collectively in only 5% of patients. Dyspareunia was the most common of the 3 "Ds." Twenty-seven percent of patients had none of the classic 3Ds. On physical examination, the most common finding was a tender anterior vaginal wall mass (52%). Presenting signs and symptoms did not correlate with anatomic configuration in terms of radial urethral involvement, size, or length of urethral involvement on preoperative magnetic resonance imaging. After median 14 months of follow-up, no patient reported the classic 3Ds after surgery.
  
  
  CONCLUSIONS
  Recurrent urinary tract infections, stress urinary incontinence, dyspareunia, and vaginal mass are the most common presentations of UD. The classic triad "3Ds" is rarely seen in the individual patient. Preoperative anatomic configuration on imaging is not correlated with the severity or nature of presenting symptoms.
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Nima
authors.initials: N
authors.lastname: Baradaran
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Leah R
authors.initials: LR
authors.lastname: Chiles
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Freilich
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Ross A
authors.initials: RA
authors.lastname: Rames
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Cox
authors.affiliation: Department of Urology, Medical University of South Carolina, Charleston, SC. Electronic address: rovnere@musc.edu.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Rovner
mesh_terms: D000328:Adult; D000368:Aged; D004240:Diverticulum / Q000150:complications / Q000175:diagnosis*; D004414:Dyspareunia / Q000209:etiology; D053159:Dysuria / Q000209:etiology; D005260:Female; D006801:Humans; D008875:Middle Aged; D012189:Retrospective Studies; D063189:Symptom Assessment; D014522:Urethral Diseases / Q000150:complications / Q000175:diagnosis*; D014550:Urinary Incontinence, Stress