A Multicenter Retrospective Cohort Study Comparing Urethral Diverticulectomy with and without Pubovaginal Sling.

Abstract Objectives The objective of this study was to compare the clinical presentation, outcomes, complications and diverticulum recurrence rates in women who underwent urethral diverticulectomy with versus without a concurrent pubovaginal sling. Study Design This multi-center retrospective cohort study included women who underwent urethral diverticulectomy between Jan 1, 2000 - Dec 31, 2016. Subjects were identified by Current Procedure Terminology code and records reviewed for demographics, medical/surgical history, symptoms, preoperative testing, concomitant surgeries, and postoperative outcomes. Symptoms, recurrence rates and complications were compared between women with and without a concomitant pubovaginal sling. The primary outcome was the presence of postoperative stress urinary incontinence symptoms. Based on a stress urinary incontinence rate of 50% with no pubovaginal sling and 10% with pubovaginal sling, we needed 141 diverticulectomy alone and 8 with pubovaginal sling to achieve 83% power with p Results We identified 485 diverticulectomy cases from 11 institutions that met inclusion/exclusion criteria; 96 (19.7%) had concomitant pubovaginal sling. Women that had pubovaginal sling were older (53 vs 46, p 6 weeks) (aOR 6.98, 95% CI 2.20-22.11, p=0.001) as well as recurrent urinary tract infection (aOR 3.27, 95% CI 1.26-7.76, p=0.013). There was no significant risk to develop de novo overactive bladder (aOR 1.48, 95% CI 0.56-3.91, p=0.423) or urgency urinary incontinence (aOR 1.47, 95% CI 0.71-3.06, p=0.30). It was not protective against recurrent diverticulum (aOR 1.38, 95% CI 0.67-2.82, p=0.374). Overall diverticulum recurrence rate was 10.1% and did not differ between groups. Conclusion This large retrospective cohort study demonstrates greater resolution of stress urinary incontinence with the addition of a pubovaginal sling at the time of urethral diverticulectomy. There was a significant risk of postoperative urinary retention and recurrent urinary tract infection in the pubovaginal sling group.