Many textbooks describe the triad of dysuria, dyspareunia and dribbling as pathognomonic of urethral diverticula(UD). We describe the rate of pre and post-operative lower urinary tract symptoms(LUTS) associated with UD in a large series.

A prospectively acquired database of all 100-patients(mean age 45.8years) having excision of UD at a tertiary centre since 2004 with a minimum follow-up of 6months(6-112) was reviewed. Video-urodynamics was performed in all pre-operatively and in those with symptoms post-surgery.

Pre and post-surgical symptoms are shown in Table 1. Of those patients with pre-existing voiding symptoms all but 3 (15%) resolved by 12 months post excision. Of those with persistent/de-novo  voiding symptoms (N=6) at 12 months post excision; 1 had urethral dilatation (UDn) with temporary SPC, 2 had UDn alone, 2 had sacral neuromodulation (SNM) for high-tone none relaxing sphincter, and 1 had a urethroplasty for stricture with symptomatic resolution in all. Storage symptoms persisted post excision in 9 (24%) and had de novo onset in 7 (11%).  Storage LUTS resolved by 12-months with conservative treatment in 11(69%). 5(31%) progressed to further treatment; 4 with intra-vesical onabotulinumtoxin A, and 1 with SNM.

76% of pre-existing storage and 85% of voiding symptoms settle following excision of UD.  New onset storage and voiding symptoms occur in 11% and 4% of patients. By 12-months post UD excision storage and voiding symptoms remained in only 6% and 5% of patients.

The relationship between the presence of a UD, LUTS and urodynamic findings is complex. The study of change in LUTS, after excision of UD are important for patient counselling pre-operatively.