# Predictive value of urethral sphincter complex volume for persistent high voiding pressure in female urethral diverticulum patients post-diverticulectomy

## TL;DR

This study found that a larger urethral sphincter complex volume predicts unresolved high voiding pressure in women after surgery for urethral diverticulum.

## Contribution

The novel contribution is identifying a USCv cutoff of ≥8.2 cm³ as a predictor of unresolved high-pressure voiding post-surgery.

## Key findings

- Patients with proximal/middle UD had significantly larger urethral sphincter complex volumes than those with distal UD.
- A USCv cutoff of ≥8.2 cm³ predicted unresolved high-pressure voiding after surgery.
- Larger urethral diverticulum volumes were linked to new stress urinary incontinence post-surgery.

## Abstract

This study evaluated the relationship between urethral diverticulum volume (UDv), urethral sphincter complex volume (USCv), clinical and urodynamic characteristics, and surgical outcomes in women with UD.

A retrospective study was conducted on 53 female patients who underwent diverticulectomy for UD. They were divided into two groups: proximal/middle UD (pmUD, n = 43) and distal UD (dUD, n = 10). Preoperative assessments included videourodynamic study (VUDS) and magnetic resonance imaging, with a follow-up VUDS 1 month post-surgery.

Compared to the dUD group, pmUD patients were less likely to present with a vaginal lump (37.2% vs. 80.0%, p = 0.031) but had significantly larger USCv (9.96 ± 5.91 cm3 vs. 5.23 ± 1.19 cm3, p < 0.001) and UDv (6.27 ± 7.40 cm3 vs. 0.84 ± 0.81 cm3, p < 0.001). The pmUD patients had longer surgeries and higher recurrence rates (32.6% vs. 0%, p = 0.018). In the pmUD group, 24 patients had bladder outlet obstruction (BOO) and 25 exhibited high-pressure voiding (> 20cmH2O). No significant association was found between UDv or USCv and recurrence, unresolved BOO, or high-pressure voiding status. However, a USCv cutoff of ≥ 8.2 cm3 was identified, predicting unresolved high-pressure voiding status post-surgery (p = 0.023). Additionally, 9.3% pmUD patients developed de novo stress urinary incontinence, correlated with larger UDv (11.5 ± 14.3 cm3 vs. 5.9 ± 6.4 cm3, p = 0.02).

A USCv cutoff of ≥ 8.2 cm3 was identified as a predictor for unresolved high-pressure voiding after diverticulectomy.

The online version contains supplementary material available at 10.1007/s00345-025-05719-w.