From the Department of Urology, Mayo Clinic.
Mayo Clinic Alix School of Medicine.
Urogynecology (Phila). 2023 Jun 1;29(6):552-557. doi: 10.1097/SPV.0000000000001311. Epub 2023 Feb 4.
Urethral diverticulectomy is performed with or without concomitant pubovaginal sling (PVS). Patients with complex UD are more frequently offered concomitant PVS. However, there is paucity of literature comparing postoperative incontinence rates for patients with simple versus complex UD.
The objective of this study is to examine postoperative stress urinary incontinence (SUI) rates after Urethral Diverticulectomy without concomitant PVS for both complex and simple cases.
A retrospective cohort study was conducted among 55 patients who underwent Urethral Diverticulectomy from 2007 to 2021. Preoperative SUI was patient-reported and confirmed with cough stress test result. Complex cases were defined as circumferential or horseshoe configurations, prior diverticulectomy, and/or anti-incontinence procedure. Primary outcome was postoperative SUI. Secondary outcome was interval PVS. Complex and simple cases were compared using the Fisher exact test.
Median age was 49 years (interquartile range, 36-58 years). Median follow-up was 5.4 months (IQR, 2-24 months). Thirty of 55 (55%) cases were simple, and 25 of 55 (45%) complex. Preoperative SUI was present in 19/57 (35%) (11 complex vs 8 simple, P = 0.25). Stress urinary incontinence persisted postoperatively in 10 of 19 (52%) (6 complex vs 4 simple, P = 0.48). De novo SUI occurred in 7 of 55, 12% (4 complex vs 3 simple, P = 0.68). Overall, 17 of 55 (31%) patients had postoperative SUI (10 complex vs 7 simple, P = 0.24). Of those, 8 of 17 underwent subsequent PVS placement (P = 0.71) and 9 of 17 had resolution of pad use after physical therapy (P = 0.27).
We did not find evidence of an association between complexity and postoperative SUI. Age at surgery and preoperative frequency were the strongest predictors of postoperative SUI in this cohort. Our findings suggest successful complex urethral diverticulum repair does not require concomitant PVS.
尿道憩室切除术可单独进行，也可与耻骨阴道吊带（PVS）同时进行。复杂的尿道憩室更常与同时进行 PVS。然而，比较单纯与复杂尿道憩室患者术后尿失禁发生率的文献很少。
本研究旨在检查单纯与复杂病例在不伴耻骨阴道吊带的情况下行尿道憩室切除术的术后压力性尿失禁（SUI）发生率。
对 2007 年至 2021 年间行尿道憩室切除术的 55 例患者进行回顾性队列研究。术前 SUI 通过患者报告并咳嗽压力测试结果证实。复杂病例定义为环状或马蹄形、既往憩室切除术和/或抗失禁手术。主要结局是术后 SUI。次要结局是间隔性 PVS。采用 Fisher 精确检验比较复杂病例和简单病例。
中位年龄为 49 岁（四分位距，36-58 岁）。中位随访时间为 5.4 个月（IQR，2-24 个月）。55 例患者中 30 例（55%）为单纯病例，25 例（45%）为复杂病例。57 例患者中术前 SUI 为 19 例（35%）（11 例复杂，8 例简单，P=0.25）。术后 19 例（52%）仍存在压力性尿失禁（6 例复杂，4 例简单，P=0.48）。55 例患者中有 7 例（12%）新发 SUI，4 例（3 例简单，P=0.68）。总体而言，55 例患者中有 17 例（31%）术后出现 SUI（10 例复杂，7 例简单，P=0.24）。其中 17 例中有 8 例行后续 PVS 放置（P=0.71），17 例中有 9 例经物理治疗后缓解垫使用（P=0.27）。
我们没有发现复杂性与术后 SUI 之间存在关联的证据。在本队列中，手术时年龄和术前频率是术后 SUI 的最强预测因素。我们的研究结果表明，成功的复杂尿道憩室修复不需要同时进行耻骨阴道吊带。
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