Long-term patient-related outcomes of urethral diverticulectomies in females

Background: Female urethral diverticula (UD) are rare and when one is present, it often receives a delayed diagnosis. Limited data is present on long-term and patient-related outcomes of a diverticulectomy. We aim to evaluate the clinical presentation of UD and to assess both objective and subjective effects of diverticulectomy in women. Methods: In this retrospective study, patient files of female patients with a UD from two tertiary hospitals were reviewed. Data collected from patient files included symptoms at presentation, surgery reports and complications. Patients were interviewed over the phone to evaluate the long-term impacts of surgery. The primary outcome was defined as subjective resolution of symptoms after diverticulectomy on short-term and long- term follow-up. Secondary outcomes included complications, time from the start of symptoms until diagnosis, recurrence risk and anatomical diverticulum characteristics relevant for success of surgery. Results: 21 women were included. Urethral swelling was reported as a main symptom at presentation in 48%. Vaginal pain was the main symptom in 33% of the patients. Comparing the symptoms before diverticulectomy to the symptoms after surgery, at a mean follow-up of 36 months (range 6–78), there was a significant resolution of the sensation of a vaginal mass, dyspareunia, discharge and recurrent urinary tract infections (p < 0.05). A sensation of post-void residual, terminal dribbling and stress urinary incontinence (SUI) were reported more often after surgery than before (p < 0.05). De novo SUI was seen in 45% of the patients. Of the patients with a partially dorsally located diverticulum and those without involvement of the dorsal side of the urethra, respectively 50% and 43% experienced de novo SUI in the long-term (p = 0.57). 50% of the women were without any symptoms in the long-term and 35% reported fewer symptoms than before surgery. In four patients (20%) a recurrence was identified after surgery. Conclusion: Urethral swelling and vaginal pain are the two main symptoms of a UD. In 50% of the patients diverticulectomy results in complete resolution of symptoms and in 35% of the patients it leads to fewer symptoms. Diverticulectomy entails a considerable risk (45%) of de novo SUI, of which patients should be informed pre-operatively.