Utility of clinical parameters, cystourethroscopy, and magnetic resonance imaging in the preoperative diagnosis of urethral diverticula

Pathi, Sujatha D.; Rahn, David D.; Sailors, Joseph L.; Graziano, Vincent; Sims, Robert; Stone, Rebecca; McIntire, Donald D.; Wai, Clifford Y.

doi:10.1007/s00192-012-1841-9

Cited by 22 publications

(13 citation statements)

References 18 publications

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“…However, good agreement was noticed between major urethral abnormalities on TLUS and the diagnosis of UD on urethroscopy, with a sensitivity of 100% and a specificity of 99.8% for the diagnosis of UD on ultrasound when using urethroscopy as the gold standard. The latter is highly specific for diagnosing UD, nevertheless, it has variable reported sensitivities, as the test is largely operator-dependent, and small diverticular ostia can easily be overlooked 3,5,17 . We believe that a high degree of suspicion following TLUS might increase the sensitivity and accuracy of urethroscopy.…”

Section: Strengths and Limitationsmentioning

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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Section: Strengths and Limitationsmentioning

confidence: 99%

Translabial ultrasound imaging of urethral diverticula

Gillor

Dietz

2019

Ultrasound in Obstet & Gyne

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“…Aside from being invasive procedures that are uncomfortable for the patient, these studies can only detect diverticula that have sizeable and patent communication with the urethra. Diverticula with thin connection, as well as alternate diagnoses, are unlikely to be detected using this type of imaging [12,13]. MRI not only helps diagnose the diverticulum but also helps detect any associated complications, such as superimposed infections, presence of calculi , or malignant transformation [14].…”

Section: Urethral Diverticulummentioning

confidence: 99%

MRI of female urethra and periurethral pathologies

et al. 2015

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“…In the study of Lee et al [4], the sensitivity of cystourethroscopy was 71.4%, and in the study of Pathi et al [11], the sensitivities, specificities, positive predictive values (PPVs) and negative predictive values (NPVs) of cystourethroscopy were 33, 100, 100 and 42%, respectively. Similar to the study of Pathi, the sensitivity of cystourethroscopy in our group was only 40% (4 for 10).…”

Section: Discussionmentioning

confidence: 99%

“…A recent study showed the sensitivity, specificity, PPV and NPV of MRI for diagnosis of UD to be 100, 83, 9, and 100%, respectively [11]. However, another study showed that 24.4% of UD patients, diagnosed by MRI, had some discrepancy between the operative findings and the images of MRI, which made the search for the ostia difficult [17].…”

Section: Discussionmentioning

confidence: 99%

Preoperative 3D and 4D-CT imaging using 640-Multislice CT (640-MSCT) in diagnosis of female urethral diverticulum

Zhao

Wang

et al. 2016

World J Urol

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ObjectiveTo determine the sensitivity and specificity of 640-Multislice CT (640-MSCT) in diagnosing the female UD.Materials and methodsWe investigated 16 patients with symptomatic UDs preoperatively in our hospital from August 2010 to March 2016. The patients’ average age was 38.8 years. All patients were performed 640-MSCT of pelvis; then, 3D and 4D images were reconstructed preoperatively.ResultsIn 3D and 4D-CT images, out of 16 patients, thirteen patients had one ostium, two had 2 ostia and one had 3 ostia. Out of those thirteen patients, eight patients’ ostia were located at 5 o’clock and five patients’ at 7 o’clock. Patients with 2 ostia location were at 5 and 6 o’clock and 5 and 7 o’clock, respectively. Patients with 3 ostia location were at 5, 6 and 7 o’clock. The mean distance from the bladder neck to the ostia was 22.5 mm. The shape of UD was out-pouching in 11 patients (68.8%), U-shaped in four patients (25.0%) and circumferential in 1 patient (6.2%). The CT findings were confirmed by surgical findings.Conclusions640-MSCT is a useful tool in identifying UD’s shape and ostium (including number, location) before operation. Preoperative 640-MSCT should be an adaptable modality for clinically suspected UD patients.Advances in knowledgeSeveral imaging methods have been used to diagnose female UD. 640-MSCT may be more suitable to diagnose it for its higher sensitivity and specificity in diagnosis of female UD, especially in identifying UD’s shape and number and location of ostium.

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Utility of clinical parameters, cystourethroscopy, and magnetic resonance imaging in the preoperative diagnosis of urethral diverticula

Cited by 22 publications

References 18 publications

Translabial ultrasound imaging of urethral diverticula

Translabial ultrasound imaging of urethral diverticula

MRI of female urethra and periurethral pathologies

Preoperative 3D and 4D-CT imaging using 640-Multislice CT (640-MSCT) in diagnosis of female urethral diverticulum

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