From the Guidelines
Urethral diverticulectomy is associated with several risks, benefits, and potential complications.
Benefits
The benefits include resolution of symptoms such as dysuria, frequency, and post-void dribbling.
Risks and Potential Complications
Risks and potential complications include:
- Urinary tract infection (UTI)
- Urethral stricture formation
- Stress urinary incontinence, which may necessitate additional interventions such as urethral dilation or incontinence therapy with medications
- Post-operative complications may also include wound infection, requiring treatment with oral antibiotics 1. Some patients may have underlying anatomical abnormalities, such as urethral diverticula, which can increase the risk of recurrent UTIs and other complications 1. In such cases, imaging studies may be indicated to detect and monitor treatable conditions, and urethral diverticulectomy may be considered as a treatment option to prevent future complications 1. However, the decision to perform urethral diverticulectomy should be made on a case-by-case basis, taking into account the individual patient's symptoms, medical history, and underlying risk factors 1. It is essential to weigh the potential benefits and risks of the procedure and to discuss these with the patient before making a decision 1. Key considerations for patients undergoing urethral diverticulectomy include:
- Pre-operative antibiotic prophylaxis to reduce the risk of UTI
- Close monitoring for post-operative complications, such as wound infection or urethral stricture formation
- Follow-up care to assess the resolution of symptoms and to address any potential long-term complications 1.
From the Research
Risks of Urethral Diverticulectomy
- Recurrence of urethral diverticulum, with a reported rate of 19.7% 2
- De novo stress urinary incontinence (SUI), which can occur in up to 24% of patients immediately after surgery, although this rate may decrease with time and pelvic floor muscle training 3
- Urethrovaginal fistula, a rare but devastating complication 4
- Urethral stricture, which can occur in some cases 2, 5
- Malignancies in urethral diverticula, although rarely reported 4
Benefits of Urethral Diverticulectomy
- Resolution of symptoms such as urethral mass, dysuria, and dyspareunia in most women 3
- Improvement in quality of life for patients with symptomatic urethral diverticula
- Low rate of symptomatic diverticulum recurrence, reported as 1.4% in one study 3
Potential Complications of Urethral Diverticulectomy
- Infection, which can occur in some cases 5
- Urinary tract infections, which can be a long-term complication 4
- Newly-onset urgency, which can occur in some patients 4
- Urethral damage or injury during surgery, which can lead to complications such as urethral stricture or fistula
Surgical Techniques and Considerations
- Transvaginal diverticulectomy is a common approach, but may not be suitable for all cases, such as proximal dorsal urethral diverticula 6
- Robotic-assisted laparoscopic excision is a feasible option for complex cases, such as proximal dorsal urethral diverticula 6
- Martius labial fat pad interposition can improve symptom resolution and reduce recurrence 3
- Concurrent or staged anti-incontinence surgery may be necessary for patients with concomitant SUI 4