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- Title
The incidence and outcomes of urodynamic stress urinary incontinence in female patients with urethral diverticulum.
- Authors
Barratt, Rachel; Malde, Sachin; Pakzad, Mahreen; Hamid, Rizwan; Ockrim, Jeremy; Greenwell, Tamsin
- Abstract
Aims: To assess the incidence and management of urodynamic stress urinary incontinence (USUI) in women undergoing transvaginal excision of a urethral diverticulum (UD) at our institution. Methods: A prospective database, capturing patients undergoing urethral diverticulectomy over a 9‐year period (May 2007 to August 2016), was reviewed focusing on USUI and subsequent management. Results: One hundred patients underwent UD excision (with modified Martius labial fat‐pad flap interposition). Preoperative magnetic resonance imaging data, available in 90 patients, demonstrated that 80% had complex diverticula. Complete urodynamic data were available for 93 patients. Preoperatively, 27 patients (29%) had USUI of which 16 patients resolved with either UD excision alone (n = 8) or 3 months of pelvic floor muscle therapy (PFMT) (n = 8). All 11 with persistent postoperative USUI had video urodynamics (VUDs) confirming Blaivas type 3 USUI. Six patients had a rectus fascial pubovaginal sling (RFPVS) with success in five (83.3%) while five had a mid‐urethral obturator tape (MUT‐O) with 100% success. Sixteen patients developed de novo stress urinary incontinence (SUI) postoperatively, with resolution after PFMT in 12 (75%). VUDS identified USUI (Blaivas type 3) in two (of the remaining four) patients, managed successfully with MUT‐O (n = 1) and RFPVS (n = 1). Conclusion: Preoperative USUI is present in 29% with UD. Postoperatively, 35.5% (n = 33) have pre‐existing (19) or de novo (14) SUI, of which 60.6% (n = 20) resolves after 12 months of conservative management. Surgery for USUI is required in 13 (13.9%), with cure in 92.3%. This supports our practice to excise UD primarily and delay USUI surgery, therefore, avoiding overtreatment for the majority.
- Subjects
URINARY stress incontinence; WOMEN patients; PELVIC floor; MAGNETIC resonance imaging; STRESS management; ADHESIVE tape; OVERTREATMENT of cancer
- Publication
Neurourology & Urodynamics, 2019, Vol 38, Issue 7, p1889
- ISSN
0733-2467
- Publication type
Article
- DOI
10.1002/nau.24090