Poster, Podium & Video Sessions
Presentation Authors: Alyssa Greiman*, Lauren Rittenberg, Charleston, SC, Drew Freilich, Atlanta, GA, Ross Rames, Charleston, SC, Ahmed El-Zawahry, Springfield, IL, Michelle Koski, San Diego, CA, Eric Rovner, Charleston, SC
Introduction: Female urethral diverticula (UD) may present with a variety of different symptoms including stress urinary incontinence (SUI). Surgical repair of SUI may be done concomitantly with urethral diverticulectomy. However, some surgeons may be reluctant to repair SUI at the time of urethral diverticulectomy due to the additional surgical time and potential morbidity of anti-incontinence surgery. We assessed surgical outcomes of the concomitant treatment of SUI at the time of transvaginal urethral diverticulectomy (TVUD) based on a selective approach.
Methods: Following IRB approval, we identified patients with a UD and SUI who underwent TVUD between July 2004 and January 2016. SUI was documented before and after surgery using subjective and objective parameters. Autologous pubovaginal slings (APVS) were used selectively based on surgeon and patient preference. Postoperatively, the majority of patients were imaged prior to catheter removal with voiding-cystourethrogram.
Results: A total of 61 patients underwent surgical treatment of urethral diverticula. There were 39 patients with UD and concomitant SUI. Mean age was 53 years (range 34-77). There were 22 Caucasians, and 17 African American patients. Mean follow-up was 16.2 months (range 1-72 months). There were 24 patients (62%) with SUI that underwent concomitant APVS. Of these 24 patients, 10 (42%) had prior SUI surgery. There was resolution of SUI in 20 of 24 patients (83%) who underwent a simultaneous APVS compared to 8 of 15 patients (53%) who underwent TVUD without APVS (2 patients lost to follow-up). One patient out of 22 developed de-novo SUI following TVUD. Surgery resulted in the improvement or resolution of the majority of preoperative symptoms including recurrent urinary tract infection (UTI) (82% vs. 15%), dyspareunia (64% vs. 8%), and urgency (56% vs. 13%) (preoperative vs. postoperative). Complications included two patients with prolonged urinary retention following APVS requiring sling lysis. There were 2 patients with a recurrent UD, one of which required repair 18 months post-operatively.
Conclusions: Female UD is often associated with SUI. Surgical reconstruction of UD often results in satisfactory control of urinary symptoms including SUI when both are treated concomitantly in those with bothersome symptoms. Treatment of SUI with APVS when undergoing TVUD is feasible with satisfactory outcomes. The decision whether or not to perform concomitant APVS at time of TVUD should be made on an individual basis after appropriate counseling.
Source Of Funding: none
Medical University of South Carolina
Alyssa Greiman is a PGY3 Urology Resident at the Medical University of South Carolina in Charleston, SC. She received her Bachelor of Science degree at Northwestern University in 2009 and then completed her medical school training at Feinberg School of Medicine, Northwestern University in 2014. She plans on pursuing a fellowship in Female Pelvic Medicine and Reconstructive Surgery after completing her residency training.
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