Ganabathi K, Leach G E, Zimmern P E, Dmochowski R
Kaiser Permanente Medical Center and Urodynamics Laboratory, University of California, Los Angeles.
J Urol. 1994 Nov;152(5 Pt 1):1445-52. doi: 10.1016/s0022-5347(17)32442-4.
The presentation and management are reviewed of 63 women with urethral diverticulum seen at a single institution in 10 years. Of the women 36 (61.9%) had urinary incontinence as a presenting symptom and 20 (31.7%) had incontinence as the only presenting complaint. Diverticula were suspected in 57 cases (90.5%) based on the presence of a periurethral mass during pelvic examination. Investigations included voiding cystourethrogram, excretory urogram, urodynamic studies and recently transvaginal ultrasound. Voiding cystourethrography adequately demonstrated the diverticulum in 60 of the 63 women (95.2%). Urodynamic studies performed in 58 women revealed abnormal findings in 36 (62%), including genuine stress urinary incontinence in 28 (48.3%). The location/number/size/configuration, communication, continence classification was used to define the characteristics of the diverticula. Seven women either refused operation or had small asymptomatic diverticula not requiring treatment. Transvaginal diverticulectomy was performed using a 3-layer closure in 56 women. Concomitant bladder neck suspension was performed in 27 women with documented stress urinary incontinence and/or urethral hypermobility. With a mean followup of 70 months (range 6 to 136) 48 women (85.7%) were completely relieved of the presenting complaint. Complications of diverticulectomy included 2 small distal recurrent diverticula, 1 urethrovaginal fistula and 6 transient early urinary tract infections. None of the women had urethral stricture or recurrent urinary tract infection. Six women (22.2%) who underwent diverticulectomy and bladder neck suspension, and 3 (10.3%) treated with diverticulectomy alone had minimal urinary incontinence requiring less than 2 pads a day.
回顾了10年间在单一机构就诊的63例尿道憩室女性患者的临床表现及治疗情况。这些女性中，36例（61.9%）以尿失禁为首发症状，20例（31.7%）以尿失禁为唯一首发主诉。盆腔检查时，57例（90.5%）因存在尿道周围肿物而怀疑有憩室。检查包括排尿性膀胱尿道造影、排泄性尿路造影、尿动力学研究以及近期开展的经阴道超声检查。63例女性中，60例（95.2%）的排尿性膀胱尿道造影充分显示了憩室。58例女性进行了尿动力学研究，其中36例（62%）有异常发现，包括28例（48.3%）真性压力性尿失禁。通过憩室的位置/数量/大小/形态、连通情况、控尿分级来定义憩室的特征。7例女性要么拒绝手术，要么有小的无症状憩室而无需治疗。56例女性采用三层缝合进行经阴道憩室切除术。27例有压力性尿失禁和/或尿道活动过度记录的女性同时进行了膀胱颈悬吊术。平均随访70个月（范围6至136个月），48例女性（85.7%）的首发主诉完全缓解。憩室切除术后的并发症包括2例小的远端复发性憩室、1例尿道阴道瘘和6例短暂的早期尿路感染。所有女性均无尿道狭窄或复发性尿路感染。6例（22.2%）接受憩室切除术和膀胱颈悬吊术的女性，以及3例（10.3%）仅接受憩室切除术治疗的女性有轻度尿失禁，每天使用不到2片尿垫。
