Use of trans‐labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered

Gugliotta, Giorgio; Calagna, Gloria; Adile, Giorgio; Polito, Salvatore; Speciale, Patrizia; Perino, Antonio; Adile, Biagio

doi:10.1111/jog.12676

Cited by 17 publications

(17 citation statements)

References 20 publications

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“…Radiological modalities for evaluation of UD include: US, voiding cystourethrogram (VCUG), and MRI (Table 1). Transperineal and transvaginal US have reported sensitivity of up to 95-100% and may be useful in the intraoperative identification of the UD in difficult dissections [1,19,24] ( Figure 6). Whilst US is readily available and inexpensive without the need to expose the patient to radiation, it is highly operator dependent, and the sensitivity of this imaging modality is predicated on the skill of the sonographer, with some studies reporting a < 50% sensitivity in evaluation of known UD [1,3].…”

Section: Imagingmentioning

confidence: 99%

Urethral diverticulum: A systematic review

Greiman

Rolef

2019

Arab Journal of Urology

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Objective: To present a review of the current literature regarding the presentation, diagnosis, and treatment of female urethral diverticula (UD). Methods: A systematic search of the PubMed database was performed to identify studies evaluating female UD. Article titles, abstracts and full-text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis. Results: In all, 50 studies evaluating the presentation, diagnosis and treatment of female UD were deemed relevant for inclusion. Almost all studies were retrospective single-arm case series. Female UD are outpouchings of the urethral lumen into the surrounding connective tissue. The presentation of female UD is diverse and can range from incidental findings to lower urinary tract symptoms, frequent urinary tract infections, dyspareunia, urinary incontinence (UI), or malignancy. Repair of UD begins with an accurate assessment and diagnosis, which should include adequate radiographic imaging, usually including magnetic resonance imaging. Once the diagnosis is confirmed, the usual treatment is surgical excision and reconstruction, most often through a transvaginal approach. The principles of transvaginal urethral diverticulectomy include: removal of the entire urethral diverticulum wall, watertight closure of the urethra, multi-layered and non-overlapping closure of surrounding tissue with absorbable suture, and preservation or creation of continence. Results of surgical repair are usually excellent, although long-term recurrence of these lesions may occur. Complications of urethral diverticulectomy include urethrovaginal fistula, UI, and rarely urethral stricture. Conclusion: Whilst urethral diverticulectomy excision and reconstruction is a challenging procedure, it is ultimately satisfying for the patient and the surgeon when relief of bothersome symptoms is achieved. Adherence to principles of reconstructive surgery is important to ensure a satisfactory result.

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Section: Imagingmentioning

confidence: 99%

Urethral diverticulum: A systematic review

Greiman

Rolef

2019

Arab Journal of Urology

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“…This sonographic method was greatly enhanced by the development and optimization of multiplanar high-resolution transducers allowing the acquisition of multiple volume datasets at high spatial and temporal resolution. Several recent, small studies have shown the efficacy of TLUS using an endovaginal probe in the diagnosis of UDs 15,16 . Our study supports utilization of TLUS and introduces the use of the transabdominal probe as well as the use of multiplanar imaging, which might increase the test's specificity and improve localization of a communicating tract, as shown in Figure 3.…”

Section: Comparison With Previous Studiesmentioning

confidence: 99%

Translabial ultrasound imaging of urethral diverticula

Gillor

Dietz

2019

Ultrasound in Obstet & Gyne

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Objective Urethral diverticulum is an uncommon cause of urinary dysfunction in women, with often a significant delay in diagnosis. Urethroscopy and/or magnetic resonance imaging are/is widely used for its identification. Translabial ultrasound is an alternative, particularly since the introduction of three‐/four‐dimensional imaging. The aim of our study was to review 10 years' experience of urethral diverticula evaluated by translabial ultrasound. Methods We reviewed 4121 patients seen in a tertiary urogynecologic unit between 2008 and 2018. All women were examined using multiplanar translabial ultrasound as well as office urethroscopy. Data regarding demographics, presenting symptoms and findings on clinical examination were collected. Archived ultrasound volumes were analyzed for diverticular location, diameters, complexity and echogenicity as well as tract visualization. Results Of our study population, 23 (0.6%) were found to have a major urethral abnormality on translabial ultrasound, 15 of whom were confirmed to have a urethral diverticulum on urethroscopy. Of these, 12 had a cystic component and three were non‐cystic on imaging. Mean maximum diameter was 15.3 mm (range, 4–32 mm). In 9/15 there was a simple diverticulum, while in 6/15 it was classified as complex. A communicating tract was seen in 10/15 (67%), and this was located at the 5–7 o'clock position in 7/10 (70%). Mean urethral circumference covered by the diverticulum was 39%. Conclusions Translabial ultrasound is a valid, non‐invasive method for the diagnosis of urethral diverticulum. A cystic structure crossing the urethral rhabdosphincter has high predictive value for urethroscopic diagnosis of urethral diverticulum. Multiple hyperechogenic foci may indicate the presence of a small urethral diverticulum. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

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“…However, TV-US has the relevant disadvantage of involving direct urethral compression as well as poor resolution for deep soft tissue, inter-operator variability, and differentiating UD from other peri-urethral cystic diseases. 5,10 Referring to US techniques applied to urogynecology, a new entry is the translabial ultrasound (TL-US) approach, which has proved to be a valid option in the study of disorders of the lower urogenital tract. 30 To perform a correct TL-US evaluation, the principal procedural phases are the following: i) probe placement on the anterior vulvar commissure (directed to the anterior vaginal wall), firstly on the median sagittal plane under the pubis; ii) initial image acquisition (sagittal plane), showing the arcuate ligament of the pubis, the bladder with bladder neck and the longitudinal section of the urethra; the arcuate ligament of the pubis appears as a hyperechoic image and is a crucial landmark; the urethral lumen appears as a transonic channel bounded by hypoechoic outline; iii) image acquisition on the coronal plane (rotating the probe 90° anti-clockwise), focusing on the urethral lumen and any eventual abnormalities 5 (Figure 3).…”

Section: Ultrasonographymentioning

confidence: 99%

“…3 Although considered quite a rare condition in the past, female UD seems to have much more frequent occurrence today, perhaps due to greater attention from physicians, with a current prevalence estimated between 0.6 and 6.0%. [4][5][6] The etiology of acquired UD is still to define. In most cases, a congenital origin is attributed and major incidence is in the third to fifth decade.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic tools for female urethral diverticulum: Current perspectives

Calagna

Vella

Mugavero

et al. 2019

UIJ

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Although once considered quite a rare condition in the past, female urethral diverticulum (UD) would now appear to have a higher frequency, perhaps due to greater attention from physicians. To date, there is no agreement on which is the best method for diagnosis of female UD. Traditionally, the approach was based on quite invasive techniques, such as voiding cystourethrography, and double-balloon urethrography, with satisfactory results but relevant limitations. More recent high-resolution imaging techniques, such as 2D-3D ultrasonography (US) and magnetic resonance imaging (MRI) have also been applied in the study of the abnormalities of the female urethra. US had the advantage of the outpatient setting, non-invasiveness and absence of contrast medium use; MRI, is characterized by high sensitivity thanks to multiplanar capability, with an optimal characterization of periurethral diseases or its abnormalities, and lack of ionizing radiation. A real innovation is represented by computer tomography-voiding cystourethrography, a rapid technique that allows for high quality simultaneous 2D and 3D images of the urethra, well correlated to MRI and consequently with surgical results. Here, we report and comment the available tools in the diagnosis of female UD, focusing particularly on pros and contra of different methods.

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Use of trans‐labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered

Abstract: TL-US is a valid, mini-invasive and reproducible method to diagnose UD.

Cited by 17 publications

References 20 publications

Urethral diverticulum: A systematic review

Urethral diverticulum: A systematic review

Translabial ultrasound imaging of urethral diverticula

Diagnostic tools for female urethral diverticulum: Current perspectives

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