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Contemporary Characterization of Urethral Diverticulum

  • Reconstructed Bladder Function & Dysfunction (M Kaufman, Section Editor)
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Abstract

Purpose of review

This review summarizes the urethral diverticulum (UD) literature published since 2015 and evaluates the extent to which new contributions have changed our understanding of UD. Important components within the UD literature include its etiology, diagnosis, and surgical approach. We also examine what new evidence shows regarding UD surgical outcome data, particularly in comparing staged versus concomitant stress urinary incontinence (SUI) repair.

Recent findings

Important themes emerge from our review of the contemporary UD literature. The presentation of UD may remain elusive, with diagnosis hinging on careful history, physical exam, and imaging studies. While magnetic resonance imaging (MRI) remains the gold standard imaging modality of choice, there is increasing evidence to support the utility of ultrasound as a more cost-effective means of diagnosis. Transvaginal surgical excision and repair remains highly effective, although success decreases as complexity of the UD increases. Concomitant incontinence treatment remains the most controversial subject. Recent evidence lends support to a staged approach, making it appear less certain that a potential improvement in the rate of incontinence following UD repair is worth the downside of potentially overtreating SUI or failing to prevent de novo SUI.

Summary

The recent UD literature provides a host of new case series that allow for more informed clinical decision-making in diagnosis and treatment. Ultrasound imaging offers a promising alternative to MRI in resource-conscious settings. Recent evidence trends in favor of staged incontinence repair instead of concomitant incontinence repair, muddling the framework for standard of care and underscoring the importance of informed consent in educating UD patients.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. El-Nashar SA, et al. Incidence of female urethral diverticulum: a population-based analysis and literature review. Int Urogynecol J. 2014;25(1):73–9.

    Article  Google Scholar 

  2. Cox, L. and E.S. Rovner, Bladder and Female Urethral Diverticula, in Urology. 2021. p. 2964–2992.

  3. Baradaran N, et al. Female Urethral Diverticula in the Contemporary Era: Is the Classic Triad of the “3Ds” Still Relevant? Urology. 2016;94:53–6.

    Article  Google Scholar 

  4. Scarpero HM, Dmochowski RR, Leu PB. Female urethral diverticula. Urol Clin North Am. 2011;38(1):65-71 vi.

    Article  Google Scholar 

  5. Crescenze IM, Goldman HB. Female Urethral Diverticulum: Current Diagnosis and Management. Curr Urol Rep. 2015;16(10):71.

    Article  Google Scholar 

  6. • Mukhtar, B.M.B., et al., Urethral diverticula in women are associated with increased urethra-sphincter complex volumes: A potential role for high-tone nonrelaxing sphincter in their etiology? Neurourol Urodyn, 2019. 38(7): p. 1859–1865. Novel study for potential origins of urethral diverticula in Women

  7. Pacer E, et al. Urethral Diverticulum following Polypropylene Mesh Midurethral Slings: A Literature Review. Biomed Res Int. 2020;2020:6761581.

    Article  Google Scholar 

  8. Ockrim JL, et al. A tertiary experience of urethral diverticulectomy: diagnosis, imaging and surgical outcomes. BJU Int. 2009;103(11):1550–4.

    Article  Google Scholar 

  9. Gillor M, Dietz HP. Translabial ultrasound imaging of urethral diverticula. Ultrasound Obstet Gynecol. 2019;54(4):552–6.

    Article  CAS  Google Scholar 

  10. Gugliotta G, et al. Use of trans-labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered. J Obstet Gynaecol Res. 2015;41(7):1108–14.

    Article  Google Scholar 

  11. Wang X, et al. Preoperative Transurethral Contrast-Enhanced Ultrasonography in the Diagnosis of Female Urethral Diverticula. J Ultrasound Med. 2018;37(12):2881–9.

    Article  Google Scholar 

  12. • Okeahialam, N.A., et al., Transperineal and endovaginal ultrasound for evaluating sub-urethral masses: A comparison to magnetic resonance imaging. Ultrasound Obstet Gynecol, 2020. Compares Ultrasound to MRI in diagnostic accuracy of Urethral Diverticula.

  13. Chulroek T, et al. Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst? Abdom Radiol (NY). 2019;44(8):2852–63.

    Article  Google Scholar 

  14. •• Seth, J.H., et al., Correlation of MRI features of urethral diverticulum and pre- and post-operative stress urinary incontinence. Neurourol Urodyn, 2019. 38(1): p. 180–186. Useful large study of MRI results and continence outcomes.

  15. Nickles SW, et al. Simple vs complex urethral diverticulum: presentation and outcomes. Urology. 2014;84(6):1516–9.

    Article  Google Scholar 

  16. Osman NI, et al. The Modified Prone Jack-knife Position for the Excision of Female Urethral Diverticula. Eur Urol. 2021;79(2):290–7.

    Article  Google Scholar 

  17. Neveü P, et al. Managing female urethral diverticulum with a standardized technique using a pacifier-trick artifice to facilitate dissection. Int Urogynecol J. 2019;30(5):789–94.

    Article  Google Scholar 

  18. Lask, A., et al., Transvaginal surgical repair of large urethral diverticula with bipedicle double-opposing flaps of the periurethral fascia. Int Urogynecol J, 2020.

  19. • Yang, Y., et al., Transvaginal management of symptomatic complex urethral diverticula by definite closure of diverticula and robust reconstruction of the urethra. Transl Androl Urol, 2020. 9(3): p. 1028–1036. Included complex diverticula only with detailed operative steps.

  20. Cohen OD, et al. Robotic Excision of Vaginal Remnant/Urethral Diverticulum for Relief of Urinary Symptoms Following Phalloplasty in Transgender Men. Urology. 2020;136:158–61.

    Article  Google Scholar 

  21. • Pincus, J.B., et al., Female Urethral Diverticula: Diagnosis, Pathology, and Surgical Outcomes at an Academic, Urban Medical Center. Urology, 2019. 128: p. 42–46. Large series looking at natural history and management of diverticula.

  22. Cameron AP. Urethral diverticulum in the female: a meta-analysis of modern series. Minerva Ginecol. 2016;68(2):186–210.

    PubMed  Google Scholar 

  23. El-Nashar SA, et al. Female Urethral Diverticulum: Presentation, Diagnosis, and Predictors of Outcomes After Surgery. Female Pelvic Med Reconstr Surg. 2016;22(6):447–52.

    Article  Google Scholar 

  24. Raup VT, et al. Patient Characteristics and Perioperative Outcomes of Female Urethral Diverticulectomy: Analysis of a Multi-Institutional Prospective Database. Urology. 2015;86(4):712–5.

    Article  Google Scholar 

  25. Malde S, et al. Urethral diverticulectomy with Martius labial fat pad interposition improves symptom resolution and reduces recurrence. BJU Int. 2017;119(1):158–63.

    Article  Google Scholar 

  26. Zhou L, et al. Risk factors for recurrence in female urethral diverticulectomy: a retrospective study of 66 patients. World J Urol. 2017;35(1):139–44.

    Article  Google Scholar 

  27. Ko KJ, et al. Surgical Outcomes of Primary and Recurrent Female Urethral Diverticula. Urology. 2017;105:181–5.

    Article  Google Scholar 

  28. Malde S, et al. Preliminary report on the effect of urethral diverticulum magnetic resonance imaging configuration on the incidence of new onset urodynamic stress urinary incontinence following excision. Urol Ann. 2017;9(4):321–3.

    Article  Google Scholar 

  29. Popat S, Zimmern PE. Long-term outcomes after the excision of horseshoe urethral diverticulum. Int Urogynecol J. 2016;27(3):439–44.

    Article  Google Scholar 

  30. Sun Y, et al. Risk factors of postoperative sexual function in patients with urethral diverticulum and their partners: A cohort study of 83 women. Int Braz J Urol. 2019;45(6):1216–26.

    Article  Google Scholar 

  31. O’Connor E, et al. Urethral diverticulum carcinoma in females-a case series and review of the English and Japanese literature. Transl Androl Urol. 2018;7(4):703–29.

    Article  Google Scholar 

  32. Wyman AM, et al. A 10-Year Case Series of Surgically Managed Periurethral Masses at a Single Tertiary Care Institution. Female Pelvic Med Reconstr Surg. 2020;26(11):668–70.

    Article  Google Scholar 

  33. Reeves FA, Inman RD, Chapple CR. Management of symptomatic urethral diverticula in women: a single-centre experience. Eur Urol. 2014;66(1):164–72.

    Article  Google Scholar 

  34. •• Barratt, R., et al., The incidence and outcomes of urodynamic stress urinary incontinence in female patients with urethral diverticulum. Neurourol Urodyn, 2019. 38(7): p. 1889–1900. Stress Incontinence outcomes in large series or Urethral diverticulum patients.

  35. Enemchukwu E, et al. Autologous Pubovaginal Sling for the Treatment of Concomitant Female Urethral Diverticula and Stress Urinary Incontinence. Urology. 2015;85(6):1300–3.

    Article  Google Scholar 

  36. Greiman A, et al. Outcomes of treatment of stress urinary incontinence associated with female urethral diverticula: A selective approach. Neurourol Urodyn. 2018;37(1):478–84.

    Article  Google Scholar 

  37. •• Bradley, S.E., et al., A multicenter retrospective cohort study comparing urethral diverticulectomy with and without pubovaginal sling. Am J Obstet Gynecol, 2020. 223(2): p. 273.e1–273.e9. Large multicenter look at diverticulectomy with and without sling and associated outcomes.

  38. Portnoy O, et al. Correlation between MRI and double-balloon urethrography findings in the diagnosis of female periurethral lesions. Eur J Radiol. 2013;82(12):2183–8.

    Article  Google Scholar 

  39. Trabuco EC, et al. Medium-term comparison of continence rates after rectus fascia or midurethral sling placement. Am J Obstet Gynecol. 2009;200(3):300.e1-6.

    Article  Google Scholar 

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Correspondence to Christopher Wolter.

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Conflict of Interest

Christopher E Wolter serves on the Clinical events Committee for IMARC Research Inc. Aqsa A Khan and David J Mauler declare that they have no conflicts of interest.

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Mauler, D., Khan, A. & Wolter, C. Contemporary Characterization of Urethral Diverticulum. Curr Bladder Dysfunct Rep 17, 48–53 (2022). https://doi.org/10.1007/s11884-021-00639-y

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