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Urethral diverticula in women are associated with increased urethra‐sphincter complex volumes: A potential role for high‐tone nonrelaxing sphincter in their etiology?
Author(s) -
Mukhtar Bashir M. B.,
Solomon Eskinder,
Naaseri Sahar,
Aughwane Paul,
Pakzad Mahreen,
Hamid Rizwan,
Ockrim Jeremy L.,
Greenwell Tamsin J.
Publication year - 2019
Publication title -
neurourology and urodynamics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 90
eISSN - 1520-6777
pISSN - 0733-2467
DOI - 10.1002/nau.24080
Subject(s) - medicine , urethral diverticulum , urethra , urology , sphincter , urethral sphincter , etiology , surgery
Aims Functional obstruction secondary to a high‐tone nonrelaxing sphincter (HTNRS) may lead to the formation of a proximal‐to‐mid‐urethral diverticulum (pmUD) in patients without a history of anatomical obstruction, vaginal delivery, vaginal and/or urethral surgery, or periurethral gland infection, that is, a functional pmUD (fpmUD). We used measurements of the urethra‐sphincter complex volume (USCv) as a proxy for the maximal urethral closure pressure to evaluate this potential etiological factor. Methods We compared 17 consecutive women with fpmUD (mean age ± SD of 49.4 ± 13.2 years) with a control group consisting of 24 age‐matched women (mean age: 50.8 ± 11.2 years) with no previous urological symptoms having MRI for posthysterectomy vesicovaginal fistula, and in all 71 women (mean age: 48.1 ± 11.6 years) with classical urethral diverticulum (cpmUD) referred in the same time period. The urethra‐sphincter complex was measured using T2‐weighted MRI and OsiriX © was then used to determine the USCv. Results The mean USCv of the fpmUD group was 10.01 ± 6.97 cm 3 . The mean USCv of the cpmUD was 5.19 ± 1.19 cm 3 and for the control group was 3.92 ± 1.60 cm 3 . There was a high statistically significant ( P = .01) difference between the USCv in the fpmUD group and the USCv of both the cpmUD and the control groups. Conclusions Women with fpmUD demonstrated USCv that were significantly higher than those in women with cpmUD and the control group. These findings suggest that high pressure in the proximal urethra during voiding secondary to a HTNRS may contribute to the formation of urethral diverticula.