EXPERIENCE WITH THE MANAGEMENT OF URETHRAL DIVERTICULUM IN 63 WOMEN

The presentation and management are reviewed of 63 women with urethral diverticulum seen at a single institution in 10 years. Of the women 3 6 (61.9%) had urinary incontinence as a presenting symptom and 20 (31. 7%) had incontinence as the only presenting complaint. Diverticula wer e suspected in 57 cases (90.5%) based on the presence of a periurethra l mass during pelvic examination. Investigations included voiding cyst ourethrogram, excretory urogram, urodynamic studies and recently trans vaginal ultrasound. Voiding cystourethrography adequately demonstrated the diverticulum in 60 of the 63 women (95.2%). Urodynamic studies pe rformed in 58 women revealed abnormal findings in 36 (62%), including genuine stress urinary incontinence in 28 (48.3%). The location/number /size/configuration, communication, continence classification was used to define the characteristics of the diverticula. Seven women either refused operation or had small asymptomatic diverticula not requiring treatment. Transvaginal diverticulectomy was performed using a 3-layer closure in 56 women. Concomitant bladder neck suspension was performe d in 27 women with documented stress urinary incontinence and/or ureth ral hypermobility. With a mean followup of 70 months (range 6 to 136) 48 women (85.7%) were completely relieved of the presenting complaint. Complications of diverticulectomy included 2 small distal recurrent d iverticula, 1 urethrovaginal fistula and 6 transient early urinary tra ct infections. None of the women had urethral stricture or recurrent u rinary tract infection. Six women (22.2%) who underwent diverticulecto my and bladder neck suspension, and 3 (10.3%) treated with diverticule ctomy alone had minimal urinary incontinence requiring less than 2 pad s a day.