Predictive value of urethral sphincter complex volume for persistent high voiding pressure in female urethral...

This study evaluated the relationship between urethral diverticulum volume (UDv), urethral sphincter complex volume (USCv), clinical and urodynamic characteristics, and surgical outcomes in women with UD.

A retrospective study was conducted on 53 female patients who underwent diverticulectomy for UD. They were divided into two groups: proximal/middle UD (pmUD, n = 43) and distal UD (dUD, n = 10). Preoperative assessments included videourodynamic study (VUDS) and magnetic resonance imaging, with a follow-up VUDS 1 month post-surgery.

Compared to the dUD group, pmUD patients were less likely to present with a vaginal lump (37.2% vs. 80.0%, p = 0.031) but had significantly larger USCv (9.96 ± 5.91 cm³ vs. 5.23 ± 1.19 cm³, p < 0.001) and UDv (6.27 ± 7.40 cm³ vs. 0.84 ± 0.81 cm³, p < 0.001). The pmUD patients had longer surgeries and higher recurrence rates (32.6% vs. 0%, p = 0.018). In the pmUD group, 24 patients had bladder outlet obstruction (BOO) and 25 exhibited high-pressure voiding (> 20cmH₂O). No significant association was found between UDv or USCv and recurrence, unresolved BOO, or high-pressure voiding status. However, a USCv cutoff of ≥ 8.2 cm³ was identified, predicting unresolved high-pressure voiding status post-surgery (p = 0.023). Additionally, 9.3% pmUD patients developed de novo stress urinary incontinence, correlated with larger UDv (11.5 ± 14.3 cm³ vs. 5.9 ± 6.4 cm³, p = 0.02).

A USCv cutoff of ≥ 8.2 cm³ was identified as a predictor for unresolved high-pressure voiding after diverticulectomy.