Female Urethral Diverticula in the Contemporary Era: is the Classic Triad of the "3D's" Still Relevant?

OBJECTIVES - To evaluate the correlation between signs and symptoms of urethral diverticulum (UD), especially the classic triad of 3D's including dysuria, dyspareunia and post void dribbling, before and after transvaginal urethral diverticulectomy (TVUD) in relation to anatomic configuration on imaging.

METHODS - After IRB approval, records of 54 females who underwent TVUD were retrospectively reviewed. Urinary symptoms before and after the procedure were correlated with the anatomical configuration of the UD on MRI.

RESULTS - The median age of the patients was 52 years (range 29-77). Common presenting symptoms were stress urinary incontinence (60%), dyspareunia (60%), and recurrent urinary tract infections (70%). The classic 3D's were present collectively in only 5% of patients. Dysparunia was the most common of the 3 "D's". 27% of patients had none of the classic 3D's. On physical examination the most common finding was a tender anterior vaginal wall mass (52%). Presenting signs and symptoms did not correlate with anatomic configuration in terms of radial urethral involvement, size, or length of urethral involvement on preoperative MRI. After median 14 months of follow-up, no patient reported the classic 3D's after surgery.

CONCLUSIONS - Recurrent urinary tract infections, stress urinary incontinence, dyspareunia and vaginal mass are the most common presentations of UD. The classic triad "3D's" is rarely seen in the individual patient. Preoperative anatomic configuration on imaging is not correlated with the severity or nature of presenting symptoms.

Urology. 2016 Apr 11 [Epub ahead of print]

Nima Baradaran, Leah R Chiles, Drew A Freilich, Ross A Rames, Lindsey Cox, Eric S Rovner

Department of Urology, Medical University of South Carolina, Charleston SC., Department of Urology, Medical University of South Carolina, Charleston SC., Department of Urology, Medical University of South Carolina, Charleston SC., Department of Urology, Medical University of South Carolina, Charleston SC., Department of Urology, Medical University of South Carolina, Charleston SC., Department of Urology, Medical University of South Carolina, Charleston SC.  

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