The surgical excision of urethral diverticula (UD) carries quantifiable risks of urodynamic stress urinary incontinence (USUI) and urethro-vaginal fistula (UVF). The most challenging group for surgical excision are the dorsal (often misnamed anterior) diverticulum and the circumferential diverticulum. We examined the outcomes of this highly challenging group of patients at a national referral centre.

A retrospective review of a database of patients treated between 2002-2017. All patients were pre-operatively assessed with videourodynamics and T2-weighted pelvic MRI.

30 patients, with mean-age 46.2yrs (28-77), and mean follow-up of 24months (7-42) had ventral origin circumferential (27) or dorsal origin (3) UD. Pre-operatively, 29 (97%) had at least one urinary symptom, 15(50%) had lump symptoms, 2(7%) had USUI and 17(57%) had evidence of bladder outflow obstruction. On MRI all circumferential UD had 360° involvement around the urethra, whilst the 3 dorsal UD had a mean of 180° involvement. 29 (97%) were excised fully and 2 (7%) had malignant histology. 7 (23%) developed de novo USUI which resolved by 12 months in 4 (57%). 8 (27%) required further surgery; 3 for persistent USUI, 2 for symptomatic high tone non-relaxing sphincter, 1 for vesicovaginal fistula, 1 for urethral stricture and 1 completion urethrectomy, cystectomy and ileal conduit for cancer.

Within this group 7% had malignant histology, suggesting a higher chance of sinister pathology. There is also a relatively high rate of de-novo USUI and other complications in this group.

This group of UD are surgically challenging, with a higher risk tariff. Patients should be managed collectively in higher volume centres.