Female Urethral Diverticula: Diagnosis, Pathology, and Surgical Outcomes at an Academic, Urban Medical Center

Objective: To describe the outcomes of a series of women diagnosed with a urethral diverticulum at an urban tertiary care center. Methods: An Institutional Review Board-approved review of a series of 78 women with a diagnosis of urethral diverticulum from 2009 to 2015 was performed. Clinical, radiographic, and pathologic data was collected by retrospective review of patient medical records. Data regarding treatment selection and postoperative outcomes were collected. A multivariable logistic regression was performed to identify preoperative variables that were associated with undergoing surgical resection. Results: Of the 78 patients reviewed, the median age was 45.5 years (interquartile range (IQR) 36.0-53.8), median body mass index was 30.4 (IQR 24.8-34.4). The most common presenting symptoms included: incontinence (39%), recurrent urinary tract infections (23%), dysuria (18%), discharge (13%), dyspareunia (12%), and hematuria (9%). Additionally, 16 (21%) women were asymptomatic. Of these 78 cases, 40 underwent surgical excision (51%). Of the remaining 38, 13 were symptomatic and lost to follow-up, 23 were managed expectantly, and 2 underwent surgery after the study period. Review of the pathology results revealed that the most common finding was squamous metaplasia (31%). There was 1 adenocarcinoma in the series (2.5%). Of the 40 patients who had surgery, 3 (7.5%) had a diverticular recurrence and 5 (12.5%) developed stress urinary incontinence. The median follow-up was 7.5 months (IQR 1-20.25 months). Conclusion: A variety of presenting symptoms existed for women with a urethral diverticulum seeking medical care at an urban medical center. When controlling for age, body mass index, and race, the presence of preoperative symptoms was associated with undergoing surgical resection.