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Management of urodynamic stress urinary incontinence in urethral diverticulum
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
857
Management of urodynamic stress urinary incontinence in urethral diverticulum Eur Urol Suppl 2017; 16(3);e1493
Barratt R., Spilotros M., Malde S., Pakzad M., Hamid R., Ockrim J., Greenwell T. University College London Hospital, Dept. of Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: Urethral diverticula are associated with urodynamic stress urinary incontinence (USUI) both pre−existing and new−onset following excision of the diverticulum. This series evaluates the incidence and management of USUI in patients with urethral diverticulum. MATERIAL & METHODS: A prospective database of all patients having urethral diverticulum excision between May 2007 and August 2016 was reviewed for all aspects of presentation, investigation, surgical outcome and post−operative follow−up. All patients had preoperative MRI and videourodynamics (VUDS) whilst those patients with persistent or new onset urinary incontinence following excision of their urethral diverticulum had post procedure VUDS at 6 months post surgery. RESULTS: 100 patients underwent urethral diverticulum excision in the period evaluated. 25 (25%) presented with pre−existing USUI. 10 (40%) had resolution of this pre−existing USUI following excision of their urethral diverticulum. Post−operatively 25 (25%) of our cohort experienced USUI (persistent or new onset). Of these 15 (65%) were patients with persistence of their pre−existing USUI. 5 (33%) had complete resolution of their USUI with conservative management only. 5 (33%) had insertion of a mid−urethral tape via the obturator route (TVT−O) with complete resolution in 4 and only 1 patient requiring further intervention with a bulking agent to further improve their symptoms. 4 (27%) patients underwent rectus fascial sling insertion with successful post−operative outcome and 1 is awaiting surgery for their persistent USUI. 10 (10%) had post−operative new onset USUI persisting at 6 months post surgey. 5 (50%) patients had complete resolution with conservative management only. 2 (20%) patients had mixed urinary incontinence and treatment for urge urinary incontinence resolved their symptoms. 2 (20%) patients achieved resolution of symptoms with a mid−urethral obturator tape (TVT−O). 1 patient developed USUI as a consequence of surgery for a post−operative urethral stricture and was treated with a rectus fascial sling and bulking agents with moderate benefit. CONCLUSIONS: 25% of patients undergoing urethral diverticulum excision will have USUI post−operatively; 10% will have new onset USUI and15% persistence of pre−existing USUI. USUI (persistent or new onset) requires surgical intervention in 56.5% of cases. Both conservative and surgical measures are feasible in this group with successful outcomes in 92%.
Eur Urol Suppl 2017; 16(3);e1493 Powered by TCPDF (www.tcpdf.org)
857
Management of urodynamic stress urinary incontinence in urethral diverticulum Eur Urol Suppl 2017; 16(3);e1493
Barratt R., Spilotros M., Malde S., Pakzad M., Hamid R., Ockrim J., Greenwell T. University College London Hospital, Dept. of Urology, London, United Kingdom INTRODUCTION & OBJECTIVES: Urethral diverticula are associated with urodynamic stress urinary incontinence (USUI) both pre−existing and new−onset following excision of the diverticulum. This series evaluates the incidence and management of USUI in patients with urethral diverticulum. MATERIAL & METHODS: A prospective database of all patients having urethral diverticulum excision between May 2007 and August 2016 was reviewed for all aspects of presentation, investigation, surgical outcome and post−operative follow−up. All patients had preoperative MRI and videourodynamics (VUDS) whilst those patients with persistent or new onset urinary incontinence following excision of their urethral diverticulum had post procedure VUDS at 6 months post surgery. RESULTS: 100 patients underwent urethral diverticulum excision in the period evaluated. 25 (25%) presented with pre−existing USUI. 10 (40%) had resolution of this pre−existing USUI following excision of their urethral diverticulum. Post−operatively 25 (25%) of our cohort experienced USUI (persistent or new onset). Of these 15 (65%) were patients with persistence of their pre−existing USUI. 5 (33%) had complete resolution of their USUI with conservative management only. 5 (33%) had insertion of a mid−urethral tape via the obturator route (TVT−O) with complete resolution in 4 and only 1 patient requiring further intervention with a bulking agent to further improve their symptoms. 4 (27%) patients underwent rectus fascial sling insertion with successful post−operative outcome and 1 is awaiting surgery for their persistent USUI. 10 (10%) had post−operative new onset USUI persisting at 6 months post surgey. 5 (50%) patients had complete resolution with conservative management only. 2 (20%) patients had mixed urinary incontinence and treatment for urge urinary incontinence resolved their symptoms. 2 (20%) patients achieved resolution of symptoms with a mid−urethral obturator tape (TVT−O). 1 patient developed USUI as a consequence of surgery for a post−operative urethral stricture and was treated with a rectus fascial sling and bulking agents with moderate benefit. CONCLUSIONS: 25% of patients undergoing urethral diverticulum excision will have USUI post−operatively; 10% will have new onset USUI and15% persistence of pre−existing USUI. USUI (persistent or new onset) requires surgical intervention in 56.5% of cases. Both conservative and surgical measures are feasible in this group with successful outcomes in 92%.
Eur Urol Suppl 2017; 16(3);e1493 Powered by TCPDF (www.tcpdf.org)