Diverticula of the female urethra--demonstrated by avoiding cystourethrograms.

Abstract

Diverticula of the female urethra have been reported repeatedly in recent literature (1–5). In symptomatic cases the treatment is surgical. Palpation, panendoscopic examination, and retrograde pressure filling of the urethra in order to demonstrate the presence of diverticula are not always effective. Radiological visualization gives the surgeon an excellent preview of their number, size, shape, and location. For this purpose voiding cystourethrography is a rapid and effective physiological procedure. The necessary sterile equipment is pictured in Figure 1. This equipment can best be handled if it is made up into a surgical pack. Image intensification, with an automatic film-changing device, and a technician familiar with the routine are also very helpful. In order to obtain the fullest co-operation of the patient, the procedure should be carefully explained to her beforehand and the room should be made as dark and quiet as possible. She is then placed supine on the radiological table and the vulvar area is prepared with surgical soap. Several large absorbent pads are placed under the hips. A catheter is inserted into the bladder and a 25 per cent solution of sterile Hypaque is injected through the catheter until the bladder is uncomfortably full. During the filling phase, intermittent fluoroscopic observation will prevent overfilling and will also aid in detecting other pathological conditions such as ureteral reflux and vesical diverticula. Once the bladder is full, the spot-film device should be centered over the urethral area and the catheter slowly removed as the patient is asked to void. As she voids onto the absorbent pads, numerous spot-films of the urethra in the anteroposterior, lateral, and oblique lateral projections should be obtained. In approximately 80 per cent of the patients not more than fifteen minutes should be required to produce spot-films of the quality illustrated in Figures 2 and 3. Any increase in time or difficulty in accomplishing the procedure is usually due to inability of the patient to void. Many women have not learned to do this in the supine position. Since the radiologist does not have time to re-educate them, he must give special attention to certain aspects of his technic: The fluoroscopy room must be kept dark and quiet; the bladder should be well filled with the contrast medium; and the catheter should not be removed until the patient feels that she absolutely must void. A final maneuver which may encourage voiding consists in elevation of the table into a semi-erect position. Part of the patient's weight is thus supported by the footboard. This places her in a more natural position for voiding and has the further advantage of gravity as an aid in initiating the flow of the contrast material.