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Srisajjakul S, Prapaisilp P, Bangchokdee S. I saw the "female prostate". Clin Imaging 2024; 113:110227. [PMID: 38909385 DOI: 10.1016/j.clinimag.2024.110227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/06/2024] [Accepted: 06/17/2024] [Indexed: 06/25/2024]
Abstract
This article delves into the diagnostic implications of the female prostate sign, a distinctive radiological sign observed in magnetic resonance imaging of female patients with substantial urethral diverticula. We discuss the association of this sign with urethral diverticula, emphasizing its mimetic resemblance to prostatic hypertrophy observed in older males. Through a comprehensive review of clinical presentations, diagnostic imaging advancements, and treatment modalities, our article underscores the significance of magnetic resonance imaging as a superior diagnostic tool. Our findings support the enhanced recognition and understanding of the female prostate sign among healthcare professionals, facilitating accurate diagnoses and informed management of urethral diverticula.
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Affiliation(s)
- Sitthipong Srisajjakul
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Patcharin Prapaisilp
- Department of Radiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Aoun R, Hermieu N, Schoentgen N, Xylinas E, Hermieu JF, Ouzaid I. Urethral Diverticulum During Pregnancy Managed With Primum Non Nocere Principle: Conservative Treatment During Pregnancy and Diverticulectomy After Child Birth. Urology 2023; 180:93-97. [PMID: 37473921 DOI: 10.1016/j.urology.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023]
Abstract
OBJECTIVE To report our referral single institution experience of the management of urethral diverticulum (UD) in female during pregnancy (UDp), which is a rare condition, not standardized and sparsely reported in the current literature. METHODS The charts of 12 female patients treated for UDp between 2010 and 2020 were screened retrospectively. Baseline demographics, management strategies, delivery complications, and surgical outcomes were specifically analyzed and compared to our historical cohort of UD patients (n = 54). RESULTS Overall, 7/12 (58%) patients were primiparous and 5/12 (42%) had previous pregnancy with no history of UD. Symptoms at diagnosis were respectively urinary tract infections (7/12, 58%), urethral purulent discharge (6/12, 50%), vaginal bulging (4/12, 33%), and dyspareunia (4/12, 33%). Compared to UD outside pregnancy, UDp patients were younger and were more likely to bear asymptomatic UD. Conservative management until delivery was elected in all patients. Vaginal delivery was possible in all but one patient. There was not any reported infectious mother-to-child transmission. Diverticulectomy through vaginal route were performed 3 months after delivery. Low-grade Clavien Dindo complications were reported in up to 25% (3/12) of the cases. No recurrence was reported. CONCLUSION Our report showed UDp could be managed conservatively during pregnancy without jeopardizing vaginal delivery and increasing infectious mother-to-child transmission. Surgical diverticulectomy could safely be performed after child birth using similar technique and care pathways generally used for the management of UD outside pregnancy.
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Affiliation(s)
- Rana Aoun
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris (AP-HP), Paris, France
| | - Nicolas Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris (AP-HP), Paris, France; University of Paris-Cité, Paris, France.
| | - Nadja Schoentgen
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris (AP-HP), Paris, France
| | - Evanguelos Xylinas
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris (AP-HP), Paris, France; University of Paris-Cité, Paris, France
| | - Jean-François Hermieu
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris (AP-HP), Paris, France; University of Paris-Cité, Paris, France
| | - Idir Ouzaid
- Department of Urology, Bichat Claude Bernard Hospital, University Hospitals of Paris (AP-HP), Paris, France; University of Paris-Cité, Paris, France
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Oamen E, Lowrey T, Tran H, Patel S, Rensing A. Robot-assisted Laparoscopic Urethral Diverticulectomy in a Pediatric Patient. Urology 2023; 177:181-183. [PMID: 37044311 DOI: 10.1016/j.urology.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/09/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023]
Abstract
Urethral diverticula are rare in children, especially in the absence of trauma. We present a case of a 9-year-old girl with pain with micturition, incontinence, and recurrent urinary tract infections. Diagnosis of urethral diverticulum was made by magnetic resonance imaging. A robot-assisted transabdominal laparoscopic diverticulectomy was performed without complication. The patient experienced a significant improvement in symptoms.
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Affiliation(s)
| | - Thomas Lowrey
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Hanh Tran
- Oklahoma Children's Hospital OU Health, Oklahoma City, OK
| | - Sanjay Patel
- OU College of Medicine Department of Urology, Oklahoma City, OK
| | - Adam Rensing
- OU College of Medicine Department of Urology, Oklahoma City, OK; Oklahoma Children's Hospital OU Health, Oklahoma City, OK.
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Touma N, Yao HH, Shamout S, Shaw J, Baverstock RJ, Carlson KV. Peri-Urethral and Anterior Vaginal Wall Masses: Does Radiological Imaging Change the Predicted Diagnosis? Neurourol Urodyn 2023; 42:746-750. [PMID: 36785951 DOI: 10.1002/nau.25147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/18/2023] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
INTRODUCTION This study aims to determine the accuracy of radiological imaging compared with surgical pathology in patients with periurethral (PU) and anterior vaginal wall (AVW) lesions. METHODS This study is a retrospective analysis of 126 women who underwent surgical treatment for PU and AVW masses between 2011 and 2020. Clinicopathological data were extracted along with radiological findings from medical records. The primary outcome was the diagnostic accuracy of preoperative imaging compared to the gold standard, pathological diagnosis. The secondary outcome was the rate of imaging correcting the clinical diagnosis. RESULTS A total of 126 women with a median age of 42 underwent surgical treatment for PU and AVW masses. The most diagnoses were periurethral cysts (PUC) (52%) and urethral diverticulum (UD) (39%). Clinical diagnosis was accurate in 102 cases (81%) for the group of pathological diagnoses. Magnetic resonance imaging (MRI) and transvaginal ultrasound (TV US) were performed in 82 (65%) and 22 (17%) cases. The accuracy of MRI and TV US for the diagnosis of PU and AVW lesions was 76% and 82%, respectively. MRI and TV US corrected the clinical diagnosis in five (6%) and two (9%) cases, respectively. Voiding cystourethrography (VCUG) and double balloon urethrography (DBU), each performed in six (5%) cases, were accurate in four (67%) and three (50%) cases. No statistical difference was found for any imaging modality compared to clinical diagnosis. CONCLUSION Clinical diagnosis based on pelvic and cystoscopy examinations was sufficient for diagnosing PU and AVW masses and was not significantly different from imaging diagnosis. Imaging may be helpful with preoperative surgical planning in selected cases.
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Affiliation(s)
- Nawar Touma
- Faculty of Medicine, McGill University, Montreal, Québec, Canada
| | - Henry H Yao
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Samer Shamout
- Faculty of Medicine, McGill University, Montreal, Québec, Canada.,Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Jordyn Shaw
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Richard J Baverstock
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
| | - Kevin V Carlson
- Department of Surgery, Division of Urology, University of Calgary, Calgary, Alberta, Canada
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Hoehn D, Mohr S, Nowakowski Ł, Mueller MD, Kuhn A. A prospective cohort trial evaluating sexual function after urethral diverticulectomy. Eur J Obstet Gynecol Reprod Biol 2022; 272:144-149. [PMID: 35313135 DOI: 10.1016/j.ejogrb.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/06/2022] [Accepted: 03/09/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Dyspareunia is a main symptom of urethral diverticulum in the female population, reported up to 60% of patients. Pain may cease after diverticulectomy as published in previous retrospective studies. To date scarce or no data exists on the postoperative outcome in terms of sexual function. The present study wants to quantify sexual function and evaluate lower urinary tract symptoms in sexually active patients after resection of urethral diverticulum. STUDY DESIGN In this prospective cohort trial at a tertiary referral center, we evaluated 40 female patients who presented with symptomatic urethral diverticulum and were sexually active. All of them underwent a standardized surgical procedure with inverted U-shape colpotomy between 2008 and 2018. The patients completed the Female Sexual Function Index (FSFI), which is determined by the mean score of the different domains, and underwent urodynamic assessment both at baseline examination before surgery and 12 months postoperatively. For statistical analysis, we conducted a paired Wilcoxon rank sum test analyzing the non-normally distributed non-parametric variables of the female sexual function index. RESULTS In two patients a malignancy was found in postoperative histology and received a different therapeutical approach. They have been excluded from statistical analysis. Sexual function improved in all domains (n = 38): total score (Z = -5.4, P < 0.000), satisfaction (Z = -5.3, P < 0.000), pain (Z = -5.4, P < 0.000), arousal (Z = -2.6, P = 0.010), lubrication (Z = -2.4, P = 0.020), desire (Z = -2.6, P = 0.009) and orgasm (Z = -2.2, P = 0.029). Maximum urethral closure pressure deteriorated from 39 to 36 cmH2O (P = 0.0008) and residual urine increased from 10 ml to 20 ml after surgery (P = 0.0019). No statistical significance is found for bladder capacity and free urinary flow. CONCLUSIONS All domains of the female sexual function index improved. Patients' bothersome symptoms, mainly pain may cease and sexual satisfaction increases, which is reassuring concerning patients' preoperative consent. We should be aware that occasionally an unexpected malignancy may be detected and it is mandatory to examine all excised tissue histologically. Lower urinary tract function remains clinically unchanged, although maximum urethral closure pressure deteriorated and postvoid residual increased though not being clinically significant.
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Affiliation(s)
- Diana Hoehn
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
| | - Stefan Mohr
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
| | - Łukasz Nowakowski
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland; 2nd Department of Gynaecology, Medical University of Lublin, Poland
| | - Michael D Mueller
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
| | - Annette Kuhn
- Urogynaecology, Department of Gynaecology, Women's Clinic, Inselspital, Bern, Switzerland.
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Shafat Heller L, Feiner B, Sharabi H, Brodner Y, Shrim A. Transvaginal ultrasound imaging of female urethral diverticulum before and after voiding. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 58:640-641. [PMID: 34396625 DOI: 10.1002/uog.23766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 07/31/2021] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Affiliation(s)
- L Shafat Heller
- Obstetrics and Gynecology Department, Hellel Yaffe Medical Center, Hadera Israel; Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - B Feiner
- Obstetrics and Gynecology Department, Hellel Yaffe Medical Center, Hadera Israel; Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - H Sharabi
- Obstetrics and Gynecology Department, Hellel Yaffe Medical Center, Hadera Israel; Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - Y Brodner
- Obstetrics and Gynecology Department, Hellel Yaffe Medical Center, Hadera Israel; Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
| | - A Shrim
- Obstetrics and Gynecology Department, Hellel Yaffe Medical Center, Hadera Israel; Rappaport Faculty of Medicine, Technion - Institute of Technology, Haifa, Israel
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The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J 2021; 32:501-552. [PMID: 33416968 PMCID: PMC8053188 DOI: 10.1007/s00192-020-04622-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 11/16/2020] [Indexed: 01/15/2023]
Abstract
Introduction and hypothesis To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women. Methods For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses. Results Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI. Conclusion The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.
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Gillor M, Dietz HP. Translabial ultrasound imaging of urethral diverticula. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2019; 54:552-556. [PMID: 31038237 DOI: 10.1002/uog.20305] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/13/2019] [Accepted: 04/18/2019] [Indexed: 06/09/2023]
Abstract
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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Affiliation(s)
- M Gillor
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, Australia
- Kaplan Medical Centre, Rehovot, affiliated to the Hebrew University and Hadassah School of Medicine, Jerusalem, Israel
| | - H P Dietz
- Sydney Medical School Nepean, Nepean Hospital, Penrith, NSW, Australia
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Abstract
Pelvic ultrasound with endovaginal ultrasound is often the imaging test of choice in the initial evaluation of nonpregnant women with pelvic pain. This article considers the sonographic observations and techniques useful in diagnosis of a variety of gynecologic causes of pelvic pain in these women, including ovarian hemorrhage, ovarian torsion, pelvic inflammatory disease, endometriosis (particularly deeply infiltrating endometriosis), endometriomas, adenomyosis, pelvic congestion syndrome, and malpositioned intrauterine contraceptive devices. Sonographic observations regarding a number of non-gynecologic causes of pelvic pain are also described.
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Affiliation(s)
- Maitray D Patel
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
| | - Scott W Young
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
| | - Nirvikar Dahiya
- Department of Radiology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA
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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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Managing female urethral diverticulum with a standardized technique using a pacifier-trick artifice to facilitate dissection. Int Urogynecol J 2018; 30:789-794. [PMID: 30178127 DOI: 10.1007/s00192-018-3754-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 08/12/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Managing urethral diverticula is challenging because of recurrence rate and postoperative complications. Herein, we report a standardized, single-institution experience of surgical treatment of urethral diverticula in women. METHODS The medical record of 37 female patients treated for urethral diverticula between 2005 and 2017 in a single institution were reviewed. All patients were operated in a standardized genupectoral position using a technical artifice called the pacifier trick to inflate diverticula throughout the procedure and facilitate its dissection. Symptoms at diagnosis, imaging findings, surgical parameters, postoperative complications, and recurrence rates were collected and are presented. RESULTS Median age was 39 ± 11 (range 21-67) years. At diagnosis, recurrent urinary tract infections (UTI) (67%), vaginal mass (46%), pelvic pain (43%), dyspareunia (27%), and urinary incontinence (UI) (24%) were the most commonly reported symptoms. Median operative time was 98 ± 31 (range 40-150) min. After a mean follow-up of 1 year, recurrence occurred in one (3%) patient. Immediate de novo postoperative UI decreased from 27% immediately after surgery to 3% after pelvic physical therapy. Pathological analyses found no malignant histology. CONCLUSIONS Surgical management of urethral diverticula in women is technically demanding. With our standardized pacifier-trick technique, satisfying anatomical and functional results were achieved.
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Lo TS, Jaili SB, Ibrahim R. A complicated urethrovaginal fistula following an inappropriate urethral diverticulum management. Taiwan J Obstet Gynecol 2017; 56:534-537. [PMID: 28805613 DOI: 10.1016/j.tjog.2016.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Urethral diverticulum is uncommon, therefore appropriate evaluation, preoperative planning and counseling must be done in order to make correct diagnosis and prevent complications. MATERIALS AND METHODS A case of anterior vaginal wall mass was treated elsewhere by a gynecologist as periurethral cyst abscess; incision and drainage were done but a symptom of pus discharge was observed after 2 weeks. Therefore, exploration, cyst wall excision and primary closure were done though histopathological examination surprisingly confirmed the presence of urethral tissue suggestive of diverticulum. RESULTS Subsequently, she developed persistent urinary leakage along with urethrovaginal fistula for which they again performed pervaginal multilayer closure. Patient was later referred to us with recurrent urethrovaginal fistula. We performed posterior urethral fistulectomy with anterior vaginal wall flap and multilayer closure. Three years follow up reveals complete recovery. CONCLUSION Even urethral diverticulum is a rare condition, should be kept in mind as early diagnosis and management.
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Affiliation(s)
- Tsia-Shu Lo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Keelung Medical Center, Keelung, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taipei Medical Center, Taipei, Taiwan, Republic of China; Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan, Republic of China; Chang Gung University, School of Medicine, Taoyuan, Taiwan, Republic of China.
| | - Sukanda Bin Jaili
- Department of Obstetrics and Gynaecology, Hospital Umum, Sarawak, Malaysia; Fellow of the Division of Urogynecology, Department of Obstetrics &Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China
| | - Rami Ibrahim
- Fellow of the Division of Urogynecology, Department of Obstetrics &Gynaecology, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan, Republic of China; Department of Obstetrics and Gynecology, Al-Bashir Hospital, Amman, Jordan
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Ko KJ, Suh YS, Kim TH, Lee HS, Cho WJ, Han DH, Lee KS. Surgical Outcomes of Primary and Recurrent Female Urethral Diverticula. Urology 2017; 105:181-185. [PMID: 28283414 DOI: 10.1016/j.urology.2017.02.040] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 02/26/2017] [Accepted: 02/28/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the surgical outcomes of female urethral diverticulectomy. MATERIALS AND METHODS We retrospectively analyzed the medical records of 68 patients with symptomatic urethral diverticula (UD) with at least 1 year of follow-up data following transvaginal urethral diverticulectomy conducted by a single surgeon. The presence of UD was confirmed by a preoperative magnetic resonance imaging (MRI). According to MRI findings, the UDs were classified as simple, U-shaped, or circumferential. Cure was defined as the absence of residual diverticulum on a postoperative MRI with a resolution of symptoms. RESULTS There were 27 cases (39.7%) of simple, 16 cases (23.5%) of U-shaped, and 25 cases (36.8%) of circumferential diverticula. The initial cure rate for UD was 77.9%. According to configuration, the cure rates for simple, U-shaped, and circumferential diverticula were 100%, 75.0%, and 64.0%, respectively (P = .043). Of the 15 patients with UD recurrence, 4 did not require reoperation because of symptom resolution. Of the 11 cases that underwent a second operation, 8 patients were cured: 7 via a Martius labial fat pad interposition (MLFI) procedure and 1 via simple excision without MLFI. The overall cure rate was 92.6%. The circumferential configuration was an independent factor for a lower cure rate (odds ratio, 7.97; 95% confidence interval, 1.14-55.69). CONCLUSION Transvaginal diverticulectomy is an effective treatment for female UD. The success rate of an initial surgery was significantly lower for UDs with circumferential configurations than for simple or U-shaped UDs. Regardless of the initial configuration, MLFI is a good treatment option for recurrent or persistent diverticula.
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Affiliation(s)
- Kwang Jin Ko
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yoon Seok Suh
- Department of Urology, Center for Prostate Cancer, Research Institute and Hospital of the National Cancer Center, Goyang, Republic of Korea
| | - Tae Heon Kim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hyo Serk Lee
- Department of Urology, Cheil General Hospital and Women's Healthcare Center, Dankook University College of Medicine, Seoul, Republic of Korea
| | - Won Jin Cho
- Department of Urology, Chosun University Hospital, Chosun University School of Medicine, Gwangju, Republic of Korea
| | - Deok Hyun Han
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyu-Sung Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Medical Device Management & Research, SAIHST, Sungkyunkwan University, Seoul, Republic of Korea.
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15
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Itani M, Kielar A, Menias CO, Dighe MK, Surabhi V, Prasad SR, O’Malley R, Gangadhar K, Lalwani N. MRI of female urethra and periurethral pathologies. Int Urogynecol J 2015. [DOI: 10.1007/s00192-015-2790-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Gugliotta G, Calagna G, Adile G, Polito S, Speciale P, Perino A, Adile B. Use of trans-labial ultrasound in the diagnosis of female urethral diverticula: A diagnostic option to be strongly considered. J Obstet Gynaecol Res 2015; 41:1108-14. [DOI: 10.1111/jog.12676] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 12/10/2014] [Indexed: 10/23/2022]
Affiliation(s)
| | - Gloria Calagna
- Department of Obstetrics and Gynecology; University Hospital ‘P. Giaccone’; Palermo Italy
| | - Giorgio Adile
- Urogynecology Unit; ‘Villa Sofia-Cervello’ Hospital; Palermo Italy
| | - Salvatore Polito
- Obstetrics and Gynecology; Casa di Cure ‘Triolo-Zancla’; Palermo Italy
| | - Patrizia Speciale
- Department of Obstetrics and Gynecology; University Hospital ‘P. Giaccone’; Palermo Italy
| | - Antonio Perino
- Department of Obstetrics and Gynecology; University Hospital ‘P. Giaccone’; Palermo Italy
| | - Biagio Adile
- Urogynecology Unit; ‘Villa Sofia-Cervello’ Hospital; Palermo Italy
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17
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Lin TC, Siu JJY, Chou ECL. Urethral diverticulum with multiple calculi with presentation of urinary incontinence in a female — A case report and literature review. UROLOGICAL SCIENCE 2014. [DOI: 10.1016/j.urols.2014.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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