Urethral diverticula: evaluation by urethral pressure profilometry, cystourethroscopy, and the voiding cystourethrogram

Abstract

Objective: To compare the value of urethral pressure profilometry with that of cystourethroscopy and the voiding cystourethrogram in the evaluation and management of urethral diverticula.

Methods: Twelve women with signs or symptoms of a urethral diverticulum were referred. The initial evaluation included cystourethroscopy and a voiding cystourethrogram. All then underwent urethral pressure profilometry.

Results: Nine of 12 patients had urethral diverticula, two had Skene duct cysts, and one had genuine stress incontinence. Both cystourethroscopy and voiding cystourethrography demonstrated diverticula in all patients who had them. Excision was the preliminary surgical plan in these women. Urethral pressure profilometry demonstrated a pressure depression or biphasic curve in all nine cases with diverticula. Stress incontinence was noted in one of these nine women. A biphasic curve was also noted in one woman with a Skene duct cyst and in the one who had genuine stress incontinence only. According to preset criteria for profilometry, excision was the planned operative procedure for all.

Conclusions: Cystourethroscopy and voiding cystourethrography were satisfactory techniques for diagnosing urethral diverticula and planning appropriate surgical treatment. The urethral pressure profile confirmed the presence of a diverticulum, but noted pressure depressions in cases other than diverticula. Profilometry did not change the surgical plan for treating diverticula, but allowed the planning of additional incontinence surgery in one patient.