Submited on: 31 May 2012 05:02:46 AM GMT
Published on: 31 May 2012 12:37:04 PM GMT
 
comment on female urethral diverticula
Posted by Dr. Daniele Porru on 24 Jun 2012 01:51:07 PM GMT

  • What are the main claims of the paper and how important are they?

    literature review on female urethral diverticula


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    the claims are not really new, deatails treated have already been previously discussed


  • Are the claims properly placed in the context of the previous literature?

    yes, they are


  • Do the results support the claims? If not, what other evidence is required?

    yes, the authors howevere don't report their own experience


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?

    no protocol is provided


  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    some issues are discussed in the review provided


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    no


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    no


  • Other Comments:

    In this important and specific chapter of urogynecology, today MRI has become the imaging diagnostic method of choice. Tumor in diverticulum is sometimes difficult to recognize, MRI is in fact most reliable to reveal a possible diverticular neoplasm and also offering better anatomical description of the lesion.

    Identification of a fistula, on the other hand, becomes possible performing urethroscopy with simultaneous fluid infusion and inspection of the vagina, sometimes the dye test is useful to confirm an abnormal passage.

    If severely impaired tissue quality following previous surgery is found,  a Martius fat flap can be used for repair.

    This is an excellent method although too advanced to be used as a routine. The use of a bipedicled vaginal wall flap is a more convenient way to reinforce the reconstruction;

    However this method involves burying vaginal epithelium in the perivaginal space with a potential risk of secretion and cyst formation.

    This risk has been differently appreciated when discussing similar methods but should be limited with the vaginal wall bipedicled flap technique since small lateral openings in the vaginal wall at the lateral entrances of the flap are created, enabling drainage of secreted fluid.

    A suprapubic tube is usually preferred for postoperative drainage in place of a urethral catheter; in patients with distal lesions, where transurethral division and marsupialization of the diverticular sac can be chosen,

     a urethral catheter is left at least 24 hours.

    Patients who undergo such an endoscopic operation should return after 2 to 3 months for follow-up and final inspection. Patients undergoing more advanced reconstructions are to be  reinvestigated half a year after the operation to record their continence and voiding status and the endoscopic appearance of the urethra.

  • Competing interests:
    no competing interests
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    average eperienced

  • How to cite:  Porru D .comment on female urethral diverticula[Review of the article 'Female Urethral Diverticula: A Review of the Literature ' by Gopall A].WebmedCentral 2012;3(6):WMCRW001970
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Great review
Posted by Dr. Ahmed F Kotb on 31 May 2012 12:11:45 PM GMT

  • What are the main claims of the paper and how important are they?

    Urethral diverticulum, although common, are always overlooked. I find the idea is great. I am one of urologists that are confronted daily with women diagnosed as just chronic cystitis, while thorough clinical examination sometimes give a clue like that disorder.


  • Are these claims novel? If not, please specify papers that weaken the claims to the originality of this one.

    Yes


  • Are the claims properly placed in the context of the previous literature?

    Yes


  • Do the results support the claims? If not, what other evidence is required?

    Yes


  • If a protocol is provided, for example for a randomized controlled trial, are there any important deviations from it? If so, have the authors explained adequately why the deviations occurred?
    none
  • Is the methodology valid? Does the paper offer enough details of its methodology that its experiments or its analyses could be reproduced?

    I would prefer the authors to clarify their methodology in papers search.


  • Would any other experiments or additional information improve the paper? How much better would the paper be if this extra work was done, and how difficult would such work be to do, or to provide?

    I would prefer adding personal or institutional experience.

    I would prefer adding some details on surgical techniques.


  • Is this paper outstanding in its discipline? (For example, would you like to see this work presented in a seminar at your hospital or university? Do you feel these results need to be incorporated in your next general lecture on the subject?) If yes, what makes it outstanding? If not, why not?

    I think the paper is concised and well written. with some modifications, like extra data on surgical techniques and their controversy, that can result in a more wonderful work, that I will like to see presented in my institution.


  • Other Comments:

    In my own experience:

    VCUG is very falacious, i rarely depend on it, for diagnosis of such pathology.

    I always try to escape from managing such case surgically

    if intervention is to be done, i prefer transvaginal diverticulectomy with reconstruction.

    Marsupialization always end in urethrovaginal fistula.

    I was very happy to see that review and i hope it to be seen as many urologists as possible.

    congratulations

  • Competing interests:
    No
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    Surgical experience. I get confronted with some of such cases. I did operate on few of them.

  • How to cite:  Kotb A F.Great review[Review of the article 'Female Urethral Diverticula: A Review of the Literature ' by Gopall A].WebmedCentral 2012;3(5):WMCRW001845
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