Hoehn Diana, Mohr Stefan, Nowakowski Łukasz, Mueller Michael D, Kuhn Annette
Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland; 2nd Department of Gynaecology, Medical University of Lublin, Poland.
Eur J Obstet Gynecol Reprod Biol. 2022 May;272:144-149. doi: 10.1016/j.ejogrb.2022.03.021. Epub 2022 Mar 11.
Dyspareunia is a main symptom of urethral diverticulum in the female population, reported up to 60% of patients. Pain may cease after diverticulectomy as published in previous retrospective studies. To date scarce or no data exists on the postoperative outcome in terms of sexual function. The present study wants to quantify sexual function and evaluate lower urinary tract symptoms in sexually active patients after resection of urethral diverticulum.
In this prospective cohort trial at a tertiary referral center, we evaluated 40 female patients who presented with symptomatic urethral diverticulum and were sexually active. All of them underwent a standardized surgical procedure with inverted U-shape colpotomy between 2008 and 2018. The patients completed the Female Sexual Function Index (FSFI), which is determined by the mean score of the different domains, and underwent urodynamic assessment both at baseline examination before surgery and 12 months postoperatively. For statistical analysis, we conducted a paired Wilcoxon rank sum test analyzing the non-normally distributed non-parametric variables of the female sexual function index.
In two patients a malignancy was found in postoperative histology and received a different therapeutical approach. They have been excluded from statistical analysis. Sexual function improved in all domains (n = 38): total score (Z = -5.4, P < 0.000), satisfaction (Z = -5.3, P < 0.000), pain (Z = -5.4, P < 0.000), arousal (Z = -2.6, P = 0.010), lubrication (Z = -2.4, P = 0.020), desire (Z = -2.6, P = 0.009) and orgasm (Z = -2.2, P = 0.029). Maximum urethral closure pressure deteriorated from 39 to 36 cmH2O (P = 0.0008) and residual urine increased from 10 ml to 20 ml after surgery (P = 0.0019). No statistical significance is found for bladder capacity and free urinary flow.
All domains of the female sexual function index improved. Patients' bothersome symptoms, mainly pain may cease and sexual satisfaction increases, which is reassuring concerning patients' preoperative consent. We should be aware that occasionally an unexpected malignancy may be detected and it is mandatory to examine all excised tissue histologically. Lower urinary tract function remains clinically unchanged, although maximum urethral closure pressure deteriorated and postvoid residual increased though not being clinically significant.
性交困难是女性尿道憩室的主要症状，据报道高达60%的患者有此症状。如先前的回顾性研究所述，憩室切除术后疼痛可能会消失。迄今为止，关于性功能方面的术后结果，几乎没有或根本没有相关数据。本研究旨在量化性功能，并评估尿道憩室切除术后性活跃患者的下尿路症状。
在一家三级转诊中心进行的这项前瞻性队列试验中，我们评估了40名有症状性尿道憩室且性活跃的女性患者。她们在2008年至2018年期间均接受了标准化的倒U形阴道切开术手术。患者完成了女性性功能指数（FSFI）评估，该指数由不同领域的平均得分确定，并在手术前的基线检查和术后12个月进行了尿动力学评估。为了进行统计分析，我们进行了配对Wilcoxon秩和检验，分析女性性功能指数的非正态分布非参数变量。
两名患者在术后组织学检查中发现恶性肿瘤，并接受了不同的治疗方法。他们被排除在统计分析之外。所有领域（n = 38）的性功能均有改善：总分（Z = -5.4，P < 0.000）、满意度（Z = -5.3，P < 0.000）、疼痛（Z = -5.4，P < 0.000）、性唤起（Z = -2.6，P = 0.010）、润滑（Z = -2.4，P = 0.020）、性欲（Z = -2.6，P = 0.009）和性高潮（Z = -2.2，P = 0.029）。最大尿道闭合压从39 cmH2O降至36 cmH2O（P = 0.0008），术后残余尿量从10 ml增加到20 ml（P = 0.0019）。膀胱容量和自由尿流未发现统计学意义。
女性性功能指数的所有领域均有改善。患者的困扰症状，主要是疼痛可能会消失，性满意度增加，这对于患者的术前同意来说是令人安心的。我们应该意识到，偶尔可能会检测到意外的恶性肿瘤，对所有切除组织进行组织学检查是必不可少的。尽管最大尿道闭合压下降且排尿后残余尿量增加，但下尿路功能在临床上仍保持不变，尽管这些变化在临床上并不显著。
