Introduction: Management of female urethral diverticula can be challenging and can result in stress urinary incontinence (SUI). Currently there is no consensus on management strategy to perform placement of a urethral sling concomitantly or at a delayed interval. In efforts to further elucidate this, we aimed to characterize those patients who went on to further surgical intervention for SUI after urethral diverticulectomy.
Methods: All women undergoing urethral diverticulectomy in California between January 2013 through December 2018 were identified using the Office of Statewide Health Planning and Development data sets (CPT 53230). Women who underwent a urethral sling procedure for SUI, either autologous fascial or synthetic, were identified from this cohort (CPT 57288). Women who had undergone concomitant sling at time of urethral diverticulectomy were excluded. Patient demographics such as age, race/ethnicity, payor type and comorbidities (diabetes mellitus, hypertension, obesity) were identified. Univariate (t-test and chi-square test) and multivariate analysis (multivariable logistic regression) were performed among the patient factors above and the risk of a future sling procedure.
Results: A total of 525 women (mean age 47.2 years) underwent a urethral diverticulectomy during this time period. Of these, 43 (8.2%) underwent a subsequent urethral sling. Limiting the analysis to women who had at least two years of follow up after diverticulectomy, this rate increased to 12.2%. Women of older age (51.6 vs. 41.9, p<0.001), and women with obesity (14.9% vs. 7.1%, p=0.024) were more likely to undergo a subsequent sling procedure. These effects were significant under multivariate analysis, controlling for all other factors. There was no significant effect of patient race or payor status on rates of subsequent sling procedure.
Conclusions: The rate of SUI after treatment of urethral diverticulum for which patients subsequently underwent a urethral sling procedure is not insignificant (12.2% in those with at least two years of follow up). Given that some women with SUI will not elect for surgical intervention, this suggests that an even higher number of women have bothersome incontinence. Women of older age or with obesity have a higher rate of SUI necessitating surgical treatment. Consideration of these factors for sling placement at the time of urethral diverticulum repair may avoid secondary procedures.
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