title: Urethral diverticulectomy with Martius labial fat pad interposition improves symptom resolution and reduces recurrence.
abstract: OBJECTIVE
  To assess the presenting features and medium-term symptomatic outcomes in women having excision of urethral diverticulum with Martius labial fat pad (MLFP) interposition.
  
  
  METHODS
  We reviewed our prospective database of all female patients having excision of a symptomatic urethral diverticulum between 2007 and 2015. Data on demographics, presenting symptoms and clinical features were collected, as well as postoperative outcomes.
  
  
  RESULTS
  In all, 70 women with a mean (range) age of 46.5 (24-77) years underwent excision of urethral diverticulum with MLFP interposition. The commonest presenting symptoms were a urethral mass (69%), urethral pain (61%), and dysuria (57%). Pre-existing stress urinary incontinence (SUI) was present in 41% (29) of the women. After surgery, at a mean (SD) of 18.9 (16.4) months follow-up (median 14 months), complete excision of urethral diverticulum was achieved in all the women, with resolution of urethral mass, dysuria and dyspareunia in all, and urethral pain in 81%. Immediately after surgery, 10 (24%) patients reported de novo SUI, which resolved with time and pelvic floor muscle training such that at 12 months only five (12%) reported continued SUI. There was one symptomatic diverticulum recurrence (1.4%).
  
  
  CONCLUSIONS
  The commonest presenting symptom of a female urethral diverticulum is urethral pain followed by dysuria and dyspareunia. Surgical excision with MLFP interposition results in complete resolution of symptoms in most women. The incidence of persistent de novo SUI in an expert high-volume centre is 12%.
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Sachin
authors.identifier: http://orcid.org/0000-0002-3712-9460
authors.initials: S
authors.lastname: Malde
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Néha
authors.initials: N
authors.lastname: Sihra
authors.affiliation: Department of Radiology, University College London Hospital, London, UK.
authors.forename: Sahar
authors.initials: S
authors.lastname: Naaseri
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Spilotros
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Eskinder
authors.initials: E
authors.lastname: Solomon
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Mahreen
authors.initials: M
authors.lastname: Pakzad
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Hamid
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Jeremy L
authors.initials: JL
authors.lastname: Ockrim
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Tamsin J
authors.initials: TJ
authors.lastname: Greenwell
mesh_terms: D000273:Adipose Tissue / Q000637:transplantation*; D000328:Adult; D000368:Aged; D004240:Diverticulum / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012074:Remission Induction; D014522:Urethral Diseases / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000379:methods; D014844:Vulva / Q000637:transplantation; D055815:Young Adult
keywords: female lower urinary tract symptoms; urethral diverticula; urethral diverticulectomy; urinary incontinence