Management of Incontinence After Urethral Diverticulectomy

Initial Assessment

• Urodynamic testing should be performed to determine the specific type of incontinence and underlying mechanisms, as UDS findings change management in 42.5% of cases 1
• Cystourethroscopy should be conducted to assess for urethral and bladder pathology that may affect treatment outcomes, including checking for residual diverticulum or urethral stricture 2

Management Algorithm

Step 1: Conservative Management (First 6 Months)

• Pelvic floor muscle exercises should be initiated as first-line therapy 3
• Absorbent products can be used as a temporary measure while pursuing definitive treatment 2

Step 2: Surgical Management (If Conservative Measures Fail)

• For confirmed stress urinary incontinence, autologous fascial pubovaginal sling is preferred over synthetic materials due to prior urethral surgery 4
• Synthetic sling surgery is contraindicated in patients with a history of urethral diverticulum 4

Special Considerations

• Patients should be monitored for at least one year following urethral surgery for complications including stricture formation, which typically develops within a year of injury 5