The diagnosis and surgical treatments of female urethral diverticulum / 中华泌尿外科杂志

ABSTRACT

Objective To investigate the presentation,diagnosis and surgical treatment of female urethral diverticulum.Methods From June 2005 to June 2016,56 female patients with urethral diverticulum were treated in our department.The presenting symptoms,clinical characteristics and surgical outcomes were reviewed.Mean age was 43.6 years (range 34 to 63).Patients were classified as simple and complex diverticulum (extend partially around the urethra ＞ 50％,U-shaped or circumferential) according to MRI features.Thirty-two patients hadsimple diverticulum locating in distal urethra with a mean age of 42.1 years,and 24 patients had complex diverticulum locating in proximal (8 cases) or distal urethra (16 cases) with a mean age of 45.7 years.The average diameter of the diverticulum was 2.5cm and 3.1cm respectively.There were 23 cases (71.8％) with recurrent urinary tract infection,22(68.7％) with pelvic pain,19(59.4％) with postvoid dribbling in simple diverticulum and 22 (91.7％),23 (95.8％),21 (84.5％) in complex diverticulum respectively.Patients with complex diverticulum were more likely to present with these symptoms than simple diverticulum(P ＜ 0.05).The statistical differences in preoperative frequency and urgency(68.7％ vs.75.0％),urinary incontinence(56.2％ vs.66.7％),dyspareunia(15.6％ vs.16.6％) and dysuria(9.4％ vs.4.2％) were not found between simple and complex groups.Transvaginal diverticulectomy and multiple layers closures were performed in 49 patients.A Martius flap interposition was used in 7 complex cases with severe urethral damage and insufficient periurethral fascia.Presenting symptoms and surgical outcomes were assessed according to different types of diverticulum.Results Fifty-six operations were completed successfully.The mean follow-up was 14.2 months (range 6-48 months).Recurrent urinary tract infection,pelvic pain,postvoid dribbling,urinary incontinence,dyspareunia and dysuria improved after surgery in both groups.There were statistical differences in symptom improvement before and after surgery (P ＜ 0.05) except for frequency and urgency.Postoperative symptoms in patients with complex and simple diverticulum were recurrent urinary tract infection (16.6％ vs.21.8％),pelvic pain (12.5％ vs.9.4％),postvoid dribbling (25.0％ vs.15.6％),frequency and urgency(58.3％ vs.53.1％),urinary incontinence(12.5％ vs.9.4％),dyspareunia(8.3％ vs.6.2％).There were no statistically significant differences between the postoperative symptoms of complex and simple diverticulum (P ＞ 0.05).Three(12.5％) cases of complex diverticulum recuredand cured after a following surgery.Conclusions For female patients with recurrent urinary tract infection,pelvic pain,postvoid dribbling and vaginal mass,the possibility of urethral diverticulum should be considered.MRI is an excellent imaging method for urethral diverticulum dignosis and classification.Transvaginal complete diverticulectomy,multiple layers closures are feasible and effective treatments.