JCU - Abstracts of the BAUS 2018 Scientific Meeting - June 2018 - 86
86
Journal of Clinical Urology 11(1S)
P10-6 Lower urinary tract symptoms and
urodynamic findings before and after urethral
diverticulum excision
Seth J1, Pakzad M1, Hamid R1, Ockrim J1,
Greenwell T1
1UCLH, London, United Kingdom
Introduction: Many textbooks describe the triad of dysuria, dyspareunia and dribbling as pathognomonic of urethral diverticula (UD). We describe the rate of pre and
post-operative lower urinary tract symptoms (LUTS)
associated with UD in a large series.
Materials and Methods: A prospectively acquired database of all 100-patients (mean age 45.8years) having excision of UD at a tertiary centre since 2004 with a minimum
follow-up of 6 months (6-112) was reviewed. Videourodynamics was performed in all pre-operatively and in
those with symptoms post-surgery.
Results: Pre and post-surgical symptoms are shown in
Table 1. Of those patients with pre-existing voiding symptoms all but 3 (15%) resolved by 12 months post excision.
Of those with persistent/de-novo voiding symptoms
(N=6) at 12 months post excision; 1 had urethral dilatation (UDn) with temporary SPC, 2 had UDn alone, 2 had
sacral neuromodulation (SNM) for high-tone none relaxing sphincter, and 1 had a urethroplasty for stricture with
symptomatic resolution in all. Storage symptoms persisted
post excision in 9 (24%) and had de novo onset in 7 (11%).
Storage LUTS resolved by 12-months with conservative
treatment in 11 (69%). 5 (31%) progressed to further
treatment; 4 with intra-vesical onabotulinumtoxin A, and 1
with SNM.
Conclusion: The relationship between the presence of a
UD, LUTS and urodynamic findings is complex. 76% of
pre-existing storage and 85% of voiding symptoms settle
following excision of UD. New onset storage and voiding
symptoms occur in 11% and 4% of patients. By 12-months
post UD excision storage and voiding symptoms remained
in only 6% and 5% of patients.
P10-6: Table 1. Storage and voiding symptoms and
urodynamic findings pre and post-operatively.
Pre-surgery
Storage symptoms
(frequency-urgency)
Urodynamic DO
Voiding symptoms
(poor flow)
Urodynamic BOO
Post-surgery
Persistent
New
37 (37%)
9/37 (24%)
7/63 (11%)
15 (15%)
20 (20%)
5/12 (41%)
3/20 (15%)
7/21 (33%)
3/80 (4%)
37 (37%)
8/10 (80%)
1/23 (4%)
P10-7 Circumferential and dorsal urethral
diverticula: a contemporary experience
of the most challenging group of
diverticula
Seth J1, Itam S1, Pakzad M1, Hamid R1, Ockrim J1,
Greenwell T1
1University College London Hospital, United Kingdom, 2University
College London Hospital, United Kingdom, 3University College
London Hospital, United Kingdom, 4University College London
Hospital, United Kingdom, 5University College London Hospital,
United Kingdom, 6University College London Hospital, United
Kingdom
Introduction: The surgical excision of urethral diverticula (UD) carries quantifiable risks of urodynamic stress
urinary incontinence (USUI) and urethro-vaginal fistula
(UVF). The most challenging group for surgical excision
are the dorsal (often misnamed anterior) diverticulum and
the circumferential diverticulum. We examined the outcomes of this highly challenging group of patients at a
national referral centre.
Patients and Methods: A retrospective review of a
database of patients treated between 2002-2017. All
patients were pre-operatively assessed with videourodynamics and T2-weighted pelvic MRI.
Results: 30 patients, with mean-age 46.2yrs (28-77), and
mean follow-up of 24months (7-42) had ventral origin circumferential (27) or dorsal origin (3) UD. Pre-operatively,
29 (97%) had at least one urinary symptom, 15 (50%) had
lump symptoms, 2 (7%) had USUI and 17 (57%) had evidence of bladder outflow obstruction. On MRI all circumferential UD had 360° involvement around the urethra,
whilst the 3 dorsal UD had a mean of 180° involvement.
29 (97%) were excised fully and 2 (7%) had malignant histology. 7 (23%) developed de novo USUI which resolved
by 12 months in 4 (57%). 8 (27%) required further surgery;
3 for persistent USUI, 2 for symptomatic high tone nonrelaxing sphincter, 1 for vesicovaginal fistula, 1 for urethral
stricture and 1 completion urethrectomy, cystectomy and
ileal conduit for cancer.
Conclusion: This group of UD are surgically challenging.
Within this group 7% had malignant histology, suggesting a
higher chance of sinister pathology. There is also a relatively high rate of de-novo USUI and other complications
in this group.
P10-8 Increasing vaginal repair of
vesicovaginal fistulae does not affect outcome
Itam S1, Barratt R1, Pakzad M1, Hamid R1, Ockrim J1,
Shah J1, Greenwell T1
1University College Hospital at Westmoreland Street, London, United
Kingdom
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