Citations

Introduction and Hypothesis To report on clinical presentation, diagnosis, and outcomes after treatment of female urethral diverticulum (UD). Methods Using a record linkage system, women with a new diagnosis of UD at Mayo Clinic from January 1, 1980, through December 31, 2011, were identified. The presenting symptoms, clinical characteristics, diagnosis, and management of women presenting with UD were recorded. Outcomes after surgery were assessed using survival analysis. All statistical analyses were 2-sided and P values less than 0.05 were considered significant. Statistical analysis was done using SAS version 9.2 and JMP version 9.0 (SAS Institute Inc.). Results A total of 164 cases were identified. Median age at diagnosis was 46 years (range, 21–83). The most common presenting symptom was recurrent urinary tract infection (98, 59.8%), followed by urinary incontinence (81, 49.4%), dysuria (62, 37.8%), dyspareunia (37, 22.6%), and hematuria (15, 9.1%). Examination revealed vaginal mass in 55 (33.5%) of the women. A significant trend was noted toward an increase in use of both magnetic resonance imaging and computed tomography (P < 0.001) along with a progressive decrease in use of urethrogram (P < 0.001) for diagnosis of UD over the years. Among 114 women who underwent surgical treatment for UD, 14(12.3%) women presented with recurrent UD and the 5-year recurrence rate after surgery for UD was 23.4% (95% confidence interval, 13.9–37.0) and a reoperation rate of 17.0% (95% confidence interval, 8.8–30.2) at 5 years. Conclusions Female UD is a rare and unique condition. Clinical presentation is usually nonspecific, and magnetic resonance imaging is commonly used for confirming the diagnosis. Recurrence is not uncommon, and repeat surgical intervention might be needed.

ABSTRACT Introduction Sexual function through pregnancy and the postpartum period is an important aspect of quality of life. Despite this, prospective studies are limited, and the impact of body image on sexual function has not been explored. Aim To prospectively assess the effects of pregnancy on sexual function, and explore causative factors for sexual function alterations such as body image and pelvic floor symptoms. Materials and Methods Pregnant women completed the questionnaires in the first and third trimester and at 6 months postpartum. These included general information, questions regarding sexual activity and practices, and five validated indices: the Female Sexual Function Index (FSFI), the Body Exposure during Sexual Activities Questionnaire, short forms of Urogenital Distress Inventory and Incontinence Impact Questionnaire, and the Fecal Incontinence Quality of Life Scale. Main Outcome Measures An assessment of the FSFI domains through the 6 months postpartum and relationships between sexual function, body image, and pelvic floor symptoms. Results One hundred seven women were enrolled, 63 completed the final questionnaire. Sexual function declined through pregnancy and was not recovered by postpartum (P = 0.017); sexual frequency was highest prior to becoming pregnant (P &lt; 0.0005). Sexual practices changed during pregnancy but returned to early pregnancy levels in the postpartum period. Although body image during sexual functioning did not significantly change during pregnancy, it worsened in the postpartum period (P = 0.01). In early pregnancy, low sexual function was associated with impaired body image, while in the postpartum period, worse urinary symptoms correlated with poor FSFI. Conclusion Sexual function worsens during pregnancy and is not recovered by the 6 months postpartum; poor scores may be attributable to low body image and urinary complaints.