Management of female urethral diverticula: a new classification

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.

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.

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.

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.