Evaluation Of Urethral Diverticula Research Articles

Urethral Diverticula in Women: Discrepancies Between Magnetic Resonance Imaging and Surgical Findings

Some groups consider magnetic resonance imaging the gold standard to diagnose urethral diverticula with up to 100% reported sensitivity. We describe cases contradicting this paradigm and identify reasons for discrepancies. We searched a database for women who underwent urethral diverticulum surgery from 1998 to 2008 and also underwent preoperative magnetic resonance imaging. Images were reviewed by a blinded panel of urologists and a radiologist. They came to consensus on the presence or absence, site and anatomy of urethral diverticulum or cancer, and compared operative findings. Discrepancies were classified as errors in urethral diverticulum or cancer diagnosis and errors in urethral diverticulum anatomy or site. Of 76 patients who underwent diverticulectomy 41 also underwent magnetic resonance imaging, of whom 10 (24.4%) had a discrepancy between magnetic resonance imaging and surgical findings. In 6 of these cases there were diagnosis errors and diverticula were not seen on magnetic resonance imaging in 3. One urethral diverticulum each was misdiagnosed as Bartholin's cyst and as a typical post-collagen injection appearance. A sterile abscess was incorrectly diagnosed as a urethral diverticulum. In 2 patients magnetic resonance imaging did not detect cancer within the diverticulum. A major discrepancy in anatomy made intraoperative decision making difficult in 2 patients. In cases clinically suspicious for urethral diverticulum magnetic resonance imaging had a 24.4% error rate. Serious consequences are failure to detect cancer and suboptimal treatment for urethral diverticulum. The reason for the high magnetic resonance imaging accuracy rate in other series may be that in the absence of radiological confirmation some surgeons may choose not to perform surgery. Magnetic resonance imaging is useful to assess urethral diverticula but physicians should be aware of its limitations.

Imaging of Female Urethral Diverticulum: An Update

Female urethral diverticulum is an uncommon pathologic entity and can manifest with a variety of symptoms involving the lower urinary tract. Selection of the appropriate imaging modality is critical in establishing the diagnosis. Urethrography has traditionally been used in the evaluation of urethral diverticulum but provides only intraluminal information. Ultrasonography is advantageous in that it does not involve ionizing radiation and has the capacity to help detect a diverticulum without contrast agent filling. Multidetector computed tomographic (CT) voiding urethrography yields urethral images during micturition. In addition, the diverticulum and diverticular orifice can be visualized on two- and three-dimensional reformatted CT images. Interactive virtual urethroscopy provides simulated visualization of the intraluminal anatomy and the diverticular orifice. New magnetic resonance imaging techniques that make use of a surface or endoluminal coil have higher diagnostic accuracy and can delineate the diverticular cavity and help detect related complications. Clinicians should consider the possibility of a urethral diverticulum in women with chronic or recurrent lower urinary tract symptoms. Moreover, because female urethral diverticulum is becoming more prevalent in clinical practice, radiologists should be familiar with its imaging features and with the imaging techniques that are optimal for its evaluation.

The utility of magnetic resonance imaging for diagnosis and surgical planning before transvaginal periurethral diverticulectomy in women

The objective of this paper is to report the value of magnetic resonance imaging (MRI) in the evaluation of urethral diverticulum in women. Medical records were identified by a query of urethral diverticulectomy billing data from January 1, 2000 through December 31, 2004. Patient demographics, preoperative evaluation data, and surgical outcomes were collected. Twenty-seven women were diagnosed with a urethral diverticulum during the study period. The cohort presented with a variety of symptoms. The mean time from onset of symptoms to diagnosis of a urethral diverticulum was 47 months. Seven (26%) women had a history of one or more prior diverticulectomies, and 8 (30%) had prior incontinence or other urethral surgery. Twenty-one (78%) had undergone a preoperative MRI, which detected the diverticulum in all cases. In three women, multiple other prior imaging studies had failed to identify the diverticulum despite clinical suspicion of its presence. MRI revealed an unsuspected intradiverticular carcinoma in one patient. Twenty-six women were treated with periurethral diverticulectomy, and one patient was treated with cystourethrectomy. Average follow-up was 9 (range 1-60) months. No patients had significant intraoperative complications. One patient was diagnosed (by MRI) with a recurrent diverticulum. The use of preoperative MR imaging altered the management in 15% of our patients. Furthermore, this study cohort had a long duration of complex symptoms with one-third having had prior urethral surgery. The use of MR imaging allows for accurate diagnosis and improved surgical planning.