Urethral Diverticulum: A New Complication Associated With Tension-Free Vaginal Tape

Main Category: Urology / Nephrology
Also Included In: Women's Health / Gynecology
Article Date: 23 Feb 2009 - 2:00 PDT

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UroToday.com - Urethral diverticulum is an uncommon condition and not always easy to diagnose early. Some of the symptoms of this condition are quite common. The possibility of urethral diverticulum should be included in the evaluation of women with voiding dysfunction and pelvic disorders.

Unfortunately, there is often a delay in the diagnosis of urethral diverticulum. Usually the initial diagnosis is inaccurate as the symptom of post micturition incontinence can be frequently misdiagnosed.

The presented case supports the need for an accurate diagnostic work-up when there are symptoms consistent with urethral diverticulum, including urodynamic studies, cystography, cystoscopy, and intravaginal ultrasonography. Firstly, accurate diagnosis of the urethral diverticulum requires the inclusion of this condition in the differential diagnosis of pelvic dysfunctions. The insertion of a sub-midurethral tape in a patient suffering from stress urinary incontinence because of intrinsic sphincter deficiency probably predisposes the formation of urethral diverticulum.

The high pressure in the proximal urethra - especially when the urethra is obstructed and the bladder neck is open probably is the underlying mechanism for urethral diverticulum formation. This situation can be exacerbated when there are high detrusor pressures. Furthermore, dissection in the peri-urethral area itself can be an additional predisposing factor for urethral diverticulum.

Finally, another possibility leading to the formation of a symptomatic urethral diverticulum could be a pre-existing, small urethral diverticulum. So the need of a meticulous pre-operative evaluation to exclude the existence of this condition preoperatively is recommended.

Written by Anastasios Athanasopoulos, MD as part of Beyond the Abstract on UroToday.com

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