Poster 45: The Utility of Magnetic Resonance Imaging for Surgical Planning Before Periurethral Diverticulectomy in Women

Abstract

OBJECTIVE: The objective of this study was to assess the utility of magnetic resonance imaging (MRI) to evaluate urethral diverticulum. METHODS: With approval from the Institutional Review Board, medical records were identified by a query of billing data for CPT 53230 (urethral diverticulectomy) and ICD-9 code 599.2 (urethral diverticulum) from January 1, 2000, through December 31, 2004. Data included patient demographics, preoperative evaluation, intraoperative and postoperative complications, and surgical outcome. RESULTS: Twenty-eight women of average age 46 years (range, 21–76 years) had a diagnosis of urethral diverticulum. Of these, 21 (75%) had undergone a preoperative MRI, which detected the diverticulum in all cases. In the remaining 7, all early in this experience, diagnosis was by voiding cystourethrogram. Of the 21 patients, 10 (48%) had one or more other imaging studies before surgery. In 3 of these women, multiple other imaging studies had failed to identify the diverticulum despite clinical suspicion of its presence, and in one woman, an unsuspected intradiverticular carcinoma was imaged by the MRI. In the other 6 women, the MRI accurately identified the extent of the diverticulum and in particular its extension around the urethra, which was underestimated by other imaging studies. Twenty-six women were treated with urethral diverticulectomy (20 primary, 5 secondary, and one tertiary procedures). Average follow up was 9 months (range, 0–60 months). No patient had significant intraoperative complications and one patient (evaluated by MRI) was eventually diagnosed with a recurrent diverticulum. CONCLUSIONS: We found MRI to be superior to other imaging tools for the identification of urethral diverticulum. Additionally, its ability to identify such characteristics as true size, multiplicity, relationship to the urethra, and intraluminal complexity assists in the planning of the surgical procedure, which likely reduces surgical morbidity.