Clinical Observation on the Mangement of Female Urethral Diverticulum

Moon, Kung Hyun; Kim, Hong Sik; Kim, Choung Soo; Choo, Myung Soo

Abstract

PURPOSE
Urethral diverticulum in female can be easily detected by physical examination but sometimes the diagnosis can be difficult. Difficulty in prompt diagnosis and treatment arises from the constellation of nonspecific urinary symptoms. Furthermore, treatment may be unsuccessful and result in persistent or recurrent troublesome symptoms. We reviewed our experience with managing symptomatic diverticula for the prompt diagnosis and the definite cure.
MATERIALS AND METHODS
We reviewed 33 cases of urethral diverticulectomy performed at our institution for the last 10 years. At presentation patient age ranged from 24 to 57 years (mean 39 years). Two women (6.0%) were nulliparious and average parity was 1.9 births (0-5). Investigations included voiding cystourethrogram, excretory urogram, cystourethroscopy, urodynamic studies and recently transvaginal ultrasound. Transvaginal diverticulectomy was performed using a 3-layer closure (urethral wall, periurethral fascia, vaginal wall) in all women. Concomitant bladder neck suspension was performed in 1 woman.
RESULTS
Voiding cystourethrography adquately demonstrated the diverticulum in 11 of the 14 women (78.6%). Transvaginal ultrasound was performed in 21 women and identified the diverticulum in 19 women (90.5%). Of 33 women 32 were cured (97.0%) and secondary transvaginal diverticulectomy was performed for incomplete excision of diverticulumin in 1 woman. According to McGuire's classification 13 cases were classified as pseudodiverticulum which is a mucosal herniation through a periurethral fascial defect, and the rest 20 cases as true diverticulum. This classification had no influence on the surgical success rate. Complications of diverticulectomy included 2 cases of de novo stress urinary incontinence and 1 urethrovaginal fistula.
CONCLUSIONS
Preoperative radiographic imaging helps to delineate diverticular anatomy and transvaginal ultrasound is useful test because of absence of ionizing radiation, reduced risk of infection, less invasiveness and higher detection rate than voiding cystourethrogram. With meticulous excision and 3-layer repair, definitive cure can be achieved with a single operation.