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Yang H, Gu JJ, Jiang L, Wang J, Lin L, Wang XL. Ultrasonographic Imaging Features of Female Urethral and Peri-urethral Masses: A Retrospective Study of 95 Patients. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:1896-1907. [PMID: 32448559 DOI: 10.1016/j.ultrasmedbio.2020.03.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/11/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study was to assess the imaging features of urethral and peri-urethral masses on transvaginal or transperineal ultrasound (US) in a cohort of 95 women. In this retrospective study, medical records of 95 female patients with 98 asymptomatic or symptomatic urethral and peri-urethral masses were retrospectively reviewed. Data regarding patient demographic characteristics, symptoms, signs, imaging features on 2-D and 3-D transvaginal or transperineal US, diagnostic tests and physical and intra-operative findings were extracted. The US imaging features and clinicopathologic characteristics of each urethral or peri-urethral mass were compared. On ultrasound, 39 masses (in 39 patients) were diagnosed as urethral diverticula, which manifested mostly as complex cystic masses (24/39, 61.5%); 35 masses (in 33 patients) were diagnosed as para-urethral cysts, which manifested mostly as simple cystic masses (19/35, 54.3%); 13 hypo-echoic solid masses (in 12 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral leiomyomas; hypo-echoic or heterogeneous solid masses (in 8 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral caruncles, including one complicated by malignant transformation; solid masses with mixed echogenicity (in 2 patients) exhibiting blood flow signals on color Doppler imaging were diagnosed as urethral squamous cell carcinoma or adenocarcinoma, and a hypoechoic solid mass (in one patient) with blood-flow signals on color Doppler imaging was diagnosed as urethral condyloma associated with human papillomavirus infection. This study confirmed transvaginal or transperineal 2-D and 3-D ultrasonography to be a valid, non-invasive, cost-effective diagnostic modality for the differential diagnosis of urethral and periurethral masses.
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Affiliation(s)
- Hua Yang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Jiao-Jiao Gu
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Luo Jiang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Jie Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Lin Lin
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China
| | - Xin-Lu Wang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, Republic of China.
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Wang X, Dou C, Yan Y, Song L, Hu B, Ying T. Preoperative Transurethral Contrast-Enhanced Ultrasonography in the Diagnosis of Female Urethral Diverticula. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:2881-2889. [PMID: 29689620 DOI: 10.1002/jum.14648] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 02/28/2018] [Accepted: 03/12/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To explore the value of transurethral contrast-enhanced ultrasonography (CEUS) in the diagnosis and evaluation of female urethral diverticula. METHODS This study prospectively enrolled 35 women with periurethral cystic lesions, who underwent preoperative transurethral CEUS at our single center between April 2015 and May 2017. The diagnosis of a urethral diverticulum was made by the detection of microbubbles inside the lesion. Data regarding the structure and ostia of the diverticula were collected and then compared with intraoperative findings. RESULTS The median (interquartile range) age of the 35 patients was 43 (34-48) years. The most common manifestations were dysuria (43%) and palpable masses (40%). On transurethral CEUS, 20 patients were found to have urethral diverticula. The diverticula involved the proximal, mid, and distal urethra with different sizes. The shapes of the diverticula were simple in 4 patients (20%), U shaped in 8 patients (40%), and circumferential in 8 patients (40%). A total of 23 ostia were identified. Seventeen women (85%) had 1 ostium, and 3 women (15%) had 2 ostia. Twenty-one diverticular ostia (91%) were located from the 3- to 9-o'clock positions. The median (interquartile range) distance from the diverticular ostia to the bladder neck was 20 (9-31) mm. During surgery, all US presentations correlated well with surgical findings, and 21 patients were confirmed to have urethral diverticula. The transurethral CEUS had sensitivity of 95% and specificity of 100%. CONCLUSIONS Transurethral CEUS is an effective method for identifying the structure and ostium of female urethral diverticula. It may have a potential role in preoperative planning and surgical management.
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Affiliation(s)
- Xia Wang
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Chaoran Dou
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yulin Yan
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Kimura S, Kawaguchi Y, Momozono K, Noguchi M. Female urethral diverticulum containing large calculi. Urol Case Rep 2018; 18:14-15. [PMID: 29686963 PMCID: PMC5910525 DOI: 10.1016/j.eucr.2018.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/14/2018] [Indexed: 11/29/2022] Open
Abstract
Urinary stones in female urethral diverticulum are rarely seen. We report a 79-year-old woman who presented with irritative lower urinary tract symptoms and vaginal cystocele with incontinence. The urethral stones in the diverticulum were successfully extracted through the trans-urethral route and anterior tension-free vaginal mesh was applied one month later. The patient has been well, with no lower urinary symptoms or incontinence for 4 months.
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Affiliation(s)
- Shoichi Kimura
- Department of Urology, Omuta City Hospital, Omuta, Japan
| | | | | | - Masanori Noguchi
- Department of Urology, Kurume University School of Medicine, Kurume, Japan.,Clinical Research Division, Research Center for Innovative Cancer Therapy, Kurume University School of Medicine, Kurume, Japan
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Ultrasonographic Features of Female Urethral Diverticula: A Retrospective Study of 25 Patients. Female Pelvic Med Reconstr Surg 2017; 23:343-347. [PMID: 28106654 DOI: 10.1097/spv.0000000000000378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This article summarizes the ultrasonographic features of female urethral diverticula on biplane transrectal ultrasound (B-TRUS). METHODS A retrospective study was performed with 25 consecutive women who were diagnosed and treated as having urethral diverticulum (UD) between January 2012 and March 2016. All the patients were preoperatively evaluated using B-TRUS. The number, location, configuration, size, and type of the UD on B-TRUS were assessed. RESULTS Twenty-eight diverticula were found on B-TRUS. Twenty-two patients had single diverticulum, whereas the other 3 had double diverticula. The locations included proximal (14%), mid (46%), and distal (40%) urethra. In transverse section, the configuration presented as round or oval (46%), and horseshoe-like or circumferential (54%). The maximal diameter of the 28 diverticula ranged from 3 to 48 mm. The types contained simple UD (36%) and complex UD (64%). Color blood flow signal could be detected in the septa, cystic wall, and solid mass, whereas negative in other areas inside the UD. CONCLUSIONS Various sonographic characters of female UD could be observed during the evaluation, including single or multiple diverticula, different sites, diverse shapes, and septa, calculi, or neoplasm inside diverticulum, all of which could be clearly displayed on B-TRUS.
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Statoua M, El Ghanmi J, Karmouni T, El Khader K, Koutani A, Attya AI. [Diverticulum of the female urethra: about 18 cases]. Pan Afr Med J 2014; 18:78. [PMID: 25400845 PMCID: PMC4231240 DOI: 10.11604/pamj.2014.18.78.4573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 05/19/2014] [Indexed: 11/23/2022] Open
Abstract
Le diverticule de l'urètre ou poche sous urétrale est une affection rare, d’étiopathogénie non clairement établie, le diagnostique est clinique confirmé par l'urétrocystographie et le traitement est principalement chirurgicale consistant en une diverticulectomie par voie transvaginale. Nous rapportons l'expérience de notre service dans la prise en charge de cette affection en présentons une étude rétrospective sur une durée de 14 ans (entre 2000 et 2014) où on a pris en charge 18 patientes qui présentait un diverticule de l'urètre, l’âge moyen était de 36 ans, une symptomatologie urinaire ramenait les patientes à consulter où le diagnostic de DU a été posé par examen clinique confirmé en précisant ses caractéristiques en urétrocystographie, la prise en charge était chirurgicale et consistait en une diverticulectomie par voie transvaginale. Les suites post-opératoire était simples, la sonde vésicale retirée en moyenne 5,8 jours après l'intervention, on n'a noté aucune complication chez toute nos patientes, hormis un cas de récidives repris. Devant des troubles mictionnels récidivants de la femme, il est indispensable de rechercher un diverticule uréthral à l'examen clinique. La diverticulectomie transvaginale est l'intervention de choix offrant les meilleurs résultats.
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Affiliation(s)
- Mouad Statoua
- Clinique Urologique « B », CHU Ibn-Sina, Rabat, Maroc
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Ying T, Li Q, Shao C, Zhu Z, Feng L, Hu B. Value of transrectal ultrasonography in female traumatic urethral injuries. Urology 2010; 76:319-22. [PMID: 20156650 DOI: 10.1016/j.urology.2009.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To estimate the value of transrectal ultrasonography (TRUS) in traumatic urethral injuries of various types in females. METHODS A total of 30 female patients with symptoms of urethral injuries after trauma underwent TRUS between January 2005 and July 2008. Of them, 28 patients with operative indications undertook operation; the other 2 received conservative management and then a follow-up ultrasonography. All outcomes were used to validate the results of TRUS. RESULTS Urethral injuries were clearly observed in 30 cases with TRUS. The continuity of urethral wall, unblocking of urethral lumen, and homogeneous echo of surrounding structures had been changed. Urethral injuries varied in types, including urethrovaginal fistula, urethral stricture, urethral rupture, and urethral hematoma. It was common to find several injury patterns simultaneously in 1 patient. The outcomes in 28 cases with operative indications were consistent with results of surgery. The other 2 cases were diagnosed as urethral hematoma by TRUS which disappeared in a follow-up sonography after 3 months' conservative management. CONCLUSIONS TRUS is a reliable technique to exhibit abnormalities in injured urethra associated with trauma in female.
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Affiliation(s)
- Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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Wu YY, Li YZ, Wei Q, Li H, Hang GY, Shen H. Transvaginal sonographic diagnosis of female urethral diverticula. JOURNAL OF CLINICAL ULTRASOUND : JCU 2009; 37:40-42. [PMID: 18803310 DOI: 10.1002/jcu.20527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE We report our experience with transvaginal sonography (TVUS) in the diagnosis of female urethral diverticulum (UD). METHOD We reviewed the TVUS examinations of 4 patients with a clinical diagnosis of UD and correlated the sonographic findings with the operative findings, especially regarding the UD's size, content, and location. RESULTS All UDs were demonstrated on TVUS. The size, content, and location of the UD correlated well with the operative findings. CONCLUSION TVUS is accurate in diagnosis and determination of the size, content, and location of female UD.
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Affiliation(s)
- Yong-Yang Wu
- Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, PR China
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Chou CP, Levenson RB, Elsayes KM, Lin YH, Fu TY, Chiu YS, Huang JS, Pan HB. Imaging of Female Urethral Diverticulum: An Update. Radiographics 2008; 28:1917-30. [DOI: 10.1148/rg.287075076] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
PURPOSE OF REVIEW The purpose of this review is to summarize the presentation, investigation and management of female urethral diverticulum, a condition often overlooked and frequently misdiagnosed. Hopefully, greater awareness will lead to more timely diagnosis and appropriate treatment. RECENT FINDINGS Recently there has been considerable emphasis on correctly identifying this condition. Newer imaging modalities such as magnetic resonance imaging are now widely available and urethral diverticula that previously were unrecognized, such as noncommunicating diverticula, can now be more easily detected. The character of the diverticula can be accurately determined with appropriate imaging and this can lead to improved preoperative planning. SUMMARY Traditional contrast studies are now being superseded by advanced cross-sectional imaging such as magnetic resonance imaging and even virtual computed tomography urethroscopy. These provide much greater tissue definition; however, very few studies directly compare the myriad of contrast-based, ultrasonographic and cross-sectional investigations that are available. Therefore, although the condition is eminently treatable, there remains little standardization in the investigation of this condition. The greatest single improvement, however, in management would come from more widespread clinical awareness of the condition and its presentation.
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Affiliation(s)
- Anand K Patel
- Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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Prasad SR, Menias CO, Narra VR, Middleton WD, Mukundan G, Samadi N, Heiken JP, Siegel CL. Cross-sectional imaging of the female urethra: technique and results. Radiographics 2006; 25:749-61. [PMID: 15888623 DOI: 10.1148/rg.253045067] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical assessment of women with urethral symptoms is difficult, necessitating further evaluation with imaging. Urethrography provides limited information on luminal abnormalities of the urethra. Recent advances in ultrasound (US) and magnetic resonance (MR) imaging have dramatically improved evaluation of the female urethra, clarifying findings at physical examination and providing accurate road maps for surgeons. High-resolution transvaginal US, transperineal US, and transurethral US are reliable techniques for diagnosis and characterization of urethral abnormalities. High-resolution multiplanar MR imaging with phased-array pelvic and endovaginal coils demonstrates the urethral anatomy in greater detail. In women with urethral diverticula, US and MR imaging demonstrate the number of diverticula and the location, size, configuration, and possible contents of the sac. Most important, the position of the neck of the diverticulum may be identified for the surgeon. Imaging features do not allow differentiation between histologic subtypes of urethral carcinoma; the diagnosis is established with histopathologic examination. Periurethral cysts do not communicate with the urethra and therefore can often be differentiated from urethral diverticula at endocavitary MR imaging. High-resolution multiplanar US and MR imaging allow comprehensive evaluation of abnormalities of the female urethra.
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Affiliation(s)
- Srinivasa R Prasad
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
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Aspera AM, Rackley RR, Vasavada SP. Contemporary evaluation and management of the female urethral diverticulum. Urol Clin North Am 2002; 29:617-24. [PMID: 12476525 DOI: 10.1016/s0094-0143(02)00058-7] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We are in agreement with Davis and Telinde, who state, "The most important single diagnostic instrument for the discovery of suburethral diverticula is the high index of suspicion" [25]. The key to successful treatment of a female diverticulum is not only in the surgical management but also in the identification and evaluation of patients who present with a myriad of symptoms. It is our responsibility to include urethral diverticula in the differential diagnoses before the labels of interstitial cystitis, urethral syndrome, or urgency frequency syndrome are misplaced. The diagnosis may be elusive and the pathology difficult to identify on physical examination. However, if the index of suspicion is high and the proper radiologic imaging studies are gathered, then the correct diagnosis will often be made. The evaluation of the female urethral diverticulum has evolved greatly over the past several years. However, once appropriate diagnosis is made, the management scheme is fairly straightforward. Strict adherence to principles of surgical reconstruction allows one to eradicate the diverticulum while simultaneously preventing complications and recurrences.
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Affiliation(s)
- A Michele Aspera
- Section of Voiding Dysfunction and Female Urology, A-100 Urological Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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Abstract
Urethral diverticula are a common cause of chronic genitourinary symptoms in women. They occur in three percent of women overall with higher frequencies in selected populations of symptomatic women. The peak incidence is between the ages of 25-45 but they affect all ages. The classical presentation is with recurrent urinary tract infections and post micturition dribbling but almost any urinary symptom may be a presenting feature. Reported cure rates following surgery approach 70% for recurrent urinary tract infection and almost 100% for local symptoms such as dyspareunia. However, despite this and the availability of effective diagnostic techniques diagnosis is often delayed. This is partly due to a lack of awareness among clinicians and partly because the condition overlaps the traditional territories of gynaecologists and urologists.
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Affiliation(s)
- S J Bennett
- Senior Registrar, Dept. Obstetrics and Gynaecology, Leicester Royal Infirmary, Leicester, UK
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