Yang Yang, Zhang Muqiu, Chen Yuke, Duan Jihong, Liu Yi, Wu Shiliang
Department of Urology, Peking University First Hospital, Beijing, China.
Institute of Urology, Peking University, National Urological Cancer Center, Beijing, China.
Transl Androl Urol. 2020 Jun;9(3):1028-1036. doi: 10.21037/tau-20-478.
Management of complex urethral diverticula (UDs) is challenging not only for the ostia detection and urethral reconstruction in surgery but also for the high risk of postoperative complications. We aimed to present the experience of surgical management for UDs by transvaginal partial diverticulectomy and urethral reconstruction.
The database of medical record library was retrospectively searched for patients underwent partial diverticulectomy for symptomatic complex UDs. During the surgical procedure, the cystourethroscopy was firstly performed to locate the diverticular ostium. The surgeon exposed and opened the diverticulum along its maximum axis. The surgeon recorded the location of ostia where saline solution flowed out, when one assistant pressed suprapubic region to increase inner-pressure of bladder and urethra. We focused on definite closure of diverticular ostia and robust urethral reconstruction.
The present study included 39 patients with mean age of 45 years. There were 28 patients, 23 patients and 21 patients suffering from recurrent urinary infection, frequency and urgency. Ten patients had stress urinary incontinence. All of the 39 patients had complex UDs because of U-shaped diverticula (24/39) and circumferential diverticula (15/39). Multiloculated UDs were detected in 17 out of 39 patients. During the median follow-up time of 2.0 (1.0-12.0) years, there was no case of urinary incontinence. However, 2 patients still had mild stress urinary incontinence without additional treatment. At postoperative 3 months, five patients had para-urethral cysts with the size ranging from 0.3 to 0.4 cm, which were absorbed in follow-up.
The method of transvaginal partial diverticulectomy, definite closure of diverticular ostium, and layered reconstruction of the urethra is a feasible surgical alternative for UDs.
复杂尿道憩室（UD）的治疗具有挑战性，不仅在于手术中憩室口的检测和尿道重建，还在于术后并发症的高风险。我们旨在介绍经阴道部分憩室切除术和尿道重建术治疗UD的经验。
回顾性检索病历库中因有症状的复杂UD接受部分憩室切除术的患者。手术过程中，首先进行膀胱尿道镜检查以定位憩室口。外科医生沿憩室的最大轴线暴露并打开憩室。当一名助手按压耻骨上区域以增加膀胱和尿道内压时，外科医生记录生理盐水流出的憩室口位置。我们专注于憩室口的明确闭合和可靠的尿道重建。
本研究纳入39例患者，平均年龄45岁。分别有28例、23例和21例患者患有复发性尿路感染、尿频和尿急。10例患者有压力性尿失禁。39例患者均有复杂UD，其中U形憩室（24/39）和环形憩室（15/39）。39例患者中有17例检测到多房性UD。在中位随访时间2.0（1.0 - 12.0）年期间，无尿失禁病例。然而，2例患者仍有轻度压力性尿失禁，无需额外治疗。术后3个月，5例患者出现尿道旁囊肿，大小在0.3至0.4厘米之间，随访中囊肿吸收。
经阴道部分憩室切除术、憩室口明确闭合及尿道分层重建的方法是治疗UD的一种可行的手术选择。
