Management of female urethral diverticula: a new classification.

PURPOSE: Symptomatic female urethral diverticula may be managed by a number of operative techniques. However, to avoid persistent or recurrent diverticula definitive therapy requires analysis of the type and nature of the diverticulum. We propose a simple classification system for the management of female urethral diverticula.

MATERIALS AND METHODS: We reviewed 18 cases of urethral diverticulectomy performed at our institution in the last 5 years. Half of the patients had been treated previously elsewhere and presented with recurring or persistent symptoms. In many cases we found a pseudodiverticulum, that is a mucosal herniation through a periurethral fascial defect. We describe our clinical distinction of a true versus pseudodiverticulum. Of 7 women with symptoms of incontinence video urodynamics demonstrated stress urinary incontinence in 4 who underwent diverticulectomy and placement of a fascial sling concurrently.

RESULTS: Of 18 patients 16 were cured and 2 had persistent incontinence related to loose sling placement. Revision of the slings solved these problems. No serious complications were noted.

CONCLUSIONS: Preoperative radiographic imaging helps to delineate diverticulum anatomy. Our preoperative classifications correlated well with operative findings. With meticulous excision and repair of the periurethral fascia definitive cure was achieved with a single operation. Urodynamic assessment proved crucial in achieving a successful outcome in patients with preexisting incontinence. Contrary to opinion, simultaneous placement of a sling did not lead to retropubic infection or transvaginal erosion. The placement of a sling in 4 patients achieved lasting successful repair and continence.