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Complex Urethral Diverticulectomy: Is a Synchronous Prophylactic Autologous Fascial Sling Needed?

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This study found no significant difference in postoperative stress urinary incontinence (SUI) rates after urethral diverticulectomy between simple and complex cases. Age and preoperative frequency predicted SUI, suggesting complex urethral diverticulum repair may not need a pubovaginal sling.

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Area of Science:

  • Urology
  • Female Pelvic Medicine and Reconstructive Surgery

Background:

  • Urethral diverticulectomy (UD) is a surgical procedure for treating urethral diverticula.
  • Concomitant pubovaginal sling (PVS) is often offered for complex UD, but evidence comparing outcomes for simple versus complex cases is limited.

Purpose of the Study:

  • To evaluate postoperative stress urinary incontinence (SUI) rates after urethral diverticulectomy without PVS in both simple and complex cases.
  • To identify predictors of postoperative SUI in patients undergoing urethral diverticulectomy.

Main Methods:

  • Retrospective cohort study of 55 patients undergoing urethral diverticulectomy (2007-2021).
  • Cases were classified as simple or complex based on anatomical features and prior interventions.
  • Postoperative SUI was the primary outcome, compared between groups using Fisher exact test.

Main Results:

  • No significant difference in postoperative SUI rates was observed between simple (31%) and complex (31%) UD cases (P=0.24).
  • Preoperative SUI was present in 35% of patients, persisting postoperatively in 52% of those affected.
  • De novo SUI occurred in 12% of patients. Age and preoperative urinary frequency were significant predictors of postoperative SUI.

Conclusions:

  • Urethral diverticulum complexity did not correlate with postoperative SUI rates.
  • Concomitant pubovaginal sling may not be necessary for complex urethral diverticulum repair.
  • Age and preoperative symptoms are key predictors of SUI after urethral diverticulectomy.