Stress Urinary Incontinence After Urethral Diverticulum Repair Without Concomitant Anti-Incontinence Procedure

Recently, we read the report of Chavez et al who demonstrated that post-urethral diverticulum (UD) repair, the rate of persistent stress urinary incontinence (SUI) was present in 14 of 31 (45%) cases, and de novo SUI occurred in 4 of 30 (13%) cases. It is controversial to perform SUI and UD surgeries simultaneously, and this paper provides new evidence about this topic. At the same time, Greiman et al demonstrated that the resolution of SUI in simultaneous surgery is 83% and the resolution is 53% in UD surgery alone. The resolution rate is similar to this paper. This seems to be because a UD surgery alone can provide a diagnosis for SUI. According to our experience, UD surgery can strengthen the urethral wall, which may explain the improvement in urinary control. However, these two papers failed to report the incorrect diagnosis of SUI, and urine accumulates in the diverticulum and flows out after pressurization, which is mistaken for SUI. Meanwhile, irritative bladder symptoms are also common in women with UD and usually resolve after surgical excision. This requires more evidence to be provided for the exclusion of UD, like the cotton swab test and emptying the diverticulum and asking the patients to cough. The description by patients and questionnaires are not enough to diagnose SUI. Above all, performing SUI surgery in incorrectly diagnosed SUI patients is absolutely overtreatment, and UD surgery should not acquire credit from cured incorrectly diagnosed SUI. Moreover, as reported by Barratt et al 60.6% of postoperative SUI patients’ symptoms resolved after 12 months of conservative management. Completion of SUI and UD surgery together may increase complications due to severe infection. Therefore, simultaneous surgery is not recommended to determine whether SUI can be improved.