Peri‐Urethral and Anterior Vaginal Wall Masses: Does Radiological Imaging Change the Predicted Diagnosis?

Abstract

Introduction: This study aims to determine the accuracy of radiological imaging compared with surgical pathology in patients with periurethral (PU) and anterior vaginal wall (AVW) lesions.Methods: This study is a retrospective analysis of 126 women who underwent surgical treatment for PU and AVW masses between 2011 and 2020. Clinicopathological data were extracted along with radiological findings from medical records. The primary outcome was the diagnostic accuracy of preoperative imaging compared to the gold standard, pathological diagnosis. The secondary outcome was the rate of imaging correcting the clinical diagnosis.Results: A total of 126 women with a median age of 42 underwent surgical treatment for PU and AVW masses. The most diagnoses were periurethral cysts (PUC) (52%) and urethral diverticulum (UD) (39%). Clinical diagnosis was accurate in 102 cases (81%) for the group of pathological diagnoses.Magnetic resonance imaging (MRI) and transvaginal ultrasound (TV US) were performed in 82 (65%) and 22 (17%) cases. The accuracy of MRI and TV US for the diagnosis of PU and AVW lesions was 76% and 82%, respectively. MRI and TV US corrected the clinical diagnosis in five (6%) and two (9%) cases, respectively. Voiding cystourethrography (VCUG) and double balloon urethrography (DBU), each performed in six (5%) cases, were accurate in four (67%) and three (50%) cases. No statistical difference was found for any imaging modality compared to clinical diagnosis. Conclusion:Clinical diagnosis based on pelvic and cystoscopy examinations was sufficient for diagnosing PU and AVW masses and was not significantly different from imaging diagnosis. Imaging may be helpful with preoperative surgical planning in selected cases.

Evaluation and management of urethral and periurethral masses in women

“…In these cases, imaging is recommended. Additionally, although experienced clinicians may be able to diagnose symptomatic periurethral and urethral lesions correctly up to 80% of the time, many find imaging to be helpful for the purposes of surgical planning and patient counseling [7 ▪▪ ]. For masses that are intermittent, it is important to perform imaging when the mass is present.…”

“…In addition to being radiation-free like MRI, US is portable, can capture both static and dynamic images, is better tolerated by patients, and is cheaper than MRI. Recent studies have found US to be comparable to MRI in terms of diagnosis of urethral and periurethral female masses [4,7 ▪▪ ,10]. US is also the recommended imaging modality for assessment of midurethral sling location and function.…”

“…patients, and is cheaper than MRI. Recent studies have found US to be comparable to MRI in terms of diagnosis of urethral and periurethral female masses[4,7…”