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Kimura K, Yamamoto T, Tsuchiya J, Yoshida S, Yanai S, Onishi I, Fujii Y, Tateishi U. A diagnostic approach of various urethral diseases using multimodal imaging findings: comprehensive overview. Abdom Radiol (NY) 2024:10.1007/s00261-024-04435-0. [PMID: 38896251 DOI: 10.1007/s00261-024-04435-0] [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: 04/29/2024] [Revised: 06/05/2024] [Accepted: 06/06/2024] [Indexed: 06/21/2024]
Abstract
In clinical practice, urethral diseases are not as frequent as conditions affecting other components of the urinary system. Radiological imaging tests, such as retrograde urethrography, CT, MRI, and PET/CT, along with patient history, are crucial for accurately assessing relatively rare urethral lesions. This article aimed to provide a comprehensive overview of urethral lesions, from traumatic changes to neoplasms, and discuss the multimodal imaging findings of various urethral lesions that radiologists should know. To this end, the normal imaging anatomy of the urethra and a step-by-step approach that can be used in clinical practice have been presented to help in the systematic understanding of urethral lesions.
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Affiliation(s)
- Koichiro Kimura
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan.
| | - Tatsuya Yamamoto
- Department of Diagnostic Imaging, Cancer Institute Hospital of JFCR, Tokyo, Japan
| | - Junichi Tsuchiya
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
| | - Soichiro Yoshida
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shuichi Yanai
- Department of Radiology, Fraternity Memorial Hospital, Tokyo, Japan
| | - Iichiro Onishi
- Department of Pathology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yasuhisa Fujii
- Department of Urology, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-Ku, Tokyo, 113-8510, Japan
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Yang PJ, Chen TG, Bracher SB, Hui A, Hu DL. Urinary flow through urethras with a rough lumen. Neurourol Urodyn 2023. [PMID: 37190877 DOI: 10.1002/nau.25186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 02/01/2023] [Accepted: 03/20/2023] [Indexed: 05/17/2023]
Abstract
AIMS This study investigates how lumen roughness and urethral length influence urinary flow speed. METHODS We used micro-computed tomography scans to measure the lumen roughness and dimensions for rabbits, cats, and pigs. We designed and fabricated three-dimensional-printed urethra mimics of varying roughness and length to perform flow experiments. We also developed a corresponding mathematical model to rationalize the observed flow speed. RESULTS We update the previously reported relationship between body mass and urethra length and diameter, now including 41 measurements for urethra length and 10 measurements for diameter. We report the relationship between lumen diameter and roughness as a function of position down the urethra for rabbits, cats, and pigs. The time course of urinary speed from our mimics is reported, as well as the average speed as a function of urethra length. CONCLUSIONS Based on the behavior of our mimics, we conclude that the lumen roughness in mammals reduces flow speed by up to 25% compared to smooth urethras. Urine flows fastest when the urethra length exceeds 25 times its diameter. Longer urethras do not drain faster due to viscous effects counteracting the additional gravitational head. However, flows with our urethra mimics are still 6 times faster than those observed in nature, suggesting that further work is needed to understand flow resistance in the urethra.
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Affiliation(s)
- Patricia J Yang
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- Department of Power Mechanical Engineering, National Tsing Hua University, Hsinchu, Taiwan
| | - Tony G Chen
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- Department of Mechanical Engineering, Stanford University, Stanford, California, USA
| | - Sarah B Bracher
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- Medical College of Georgia, Augusta, Georgia, USA
| | - Aaron Hui
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - David L Hu
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
- School of Biological Sciences, Georgia Institute of Technology, Atlanta, Georgia, USA
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Barakat B, Gauger U, Rehme C, Hadaschik B, Wolff I, Hijazi S. Diagnosis of female urethral diverticulum using pelvic floor ultrasound and comparison with voiding cystourethrogram (imaging study). Int Urogynecol J 2023; 34:563-569. [PMID: 36098788 DOI: 10.1007/s00192-022-05340-0] [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: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to evaluate the sensitivity and specificity of pelvic floor ultrasound (PFUS) in the diagnostic work-up of female urethral diverticulum (UD) and to compare results of PFUS with voiding cystourethrogram (VCUG). METHODS We retrospectively reviewed our database of patients, who received VCUG and PFUS for the diagnosis of UD. A total of 196 consecutive female patients with a minimum of one symptom, such as a lower urinary tract symptom (LUTS), postmicturition dribble, dyspareunia and recurrent urinary tract infection (UTI) who underwent initial diagnostics with VCUG and PFUS were selected. Diagnostic performance of both procedures, which included size, complexity, echogenicity. and content were compared. RESULTS Recurrent UTI and LUTS were the most common symptoms, which were present in 165 (84%) and 163 patients (83%) respectively. Final diagnosis of UD was based on PFUS and VCUG findings in 69 (35%) and 58 (30%) cases respectively. Based on our study cohort, the sensitivity of PFUS in detecting UD was significantly higher than that of VCUG: 94% (IQR: 89-97) versus 78% (IQR: 73-85, p<0.01), with a trend toward higher specificity: 100% (IQR: 94-100) versus 84% (IQR: 78-84, p=0.05). Enabling direct UD visualisation, PFUS was associated with a positive predictive value (PPV) of 100% (IQR: 97-100) and a negative predictive value (NPV) of 88% (IQR: 78-95), whereas VCUG had an inferior accuracy with a PPV of 84 (IQR: 80-84) and a NPV of 68 (IQR: 62-79). CONCLUSIONS In clinical practice, VCUG has a lower sensitivity than PFUS. Based on these results, we recommend the usage of dynamic PFUS as part of a non-invasive work-up.
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Affiliation(s)
- Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, Hoserkirchweg 63, 41747, Viersen, Germany.
| | | | - Christian Rehme
- Department of Urology and Pediatric Urology, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology and Pediatric Urology, University Hospital Essen, Essen, Germany
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Sameh Hijazi
- Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany
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Mansur A, Gritskievich AA, Kostin AA, Kulchenko NG, Pospelova OM, Kalinycheva GE. Quality of life of patients with paraurethral cysts. ANDROLOGY AND GENITAL SURGERY 2023. [DOI: 10.17650/2070-9781-2022-23-4-74-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Background. Paraurethral cyst (PC) is often found in women aged 20–60 years. The prevalence of PC in the female population is 1–6 %. Since PC are often located in the distal urethra and lie close to the genitals of a woman, the symptoms associated with this disease cause women both physical and psychological suffering.Aim. To assess the quality of life of women with PC.Materials and methods. The study included female individuals (n = 106) aged 18–60 years, in whom PC were detected during examination of the perineal region. The quality of life of the patients was assessed on the basis of the health quality questionnaire – SF-36.Results. The average volume of the PC in the observed women was 3.2 ± 1.3 cm. In the observed women, the intensity of pain in the perineum was directly proportional to the duration of the disease: up to a year – 86.3 ± 4.1; from one to three years – 76.4 ± 8.3; more than three years – 64.4 ± 9.2 (p <0.05). In this regard, in this category of patients, indicators of physical activity, psychological health and role functioning due to emotional state were reduced. Repeatedor constant pain during urination and during sexual activity causes severe distress, which affects the quality of life of patients with cystic formations in the paraurethral region.Conclusion. In women with PC on the background of dyspareunia up to 3 years and more, physical and psychological aspects of health suffer.
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Affiliation(s)
- A. Mansur
- Рeoples’ Friendship University of Russia (RUDN University)
| | - A. A. Gritskievich
- Рeoples’ Friendship University of Russia (RUDN University); A.V. Vishnevsky National Medical Research Center of Surgery, Ministry of Health of Russia
| | - A. A. Kostin
- Рeoples’ Friendship University of Russia (RUDN University); National Medical Research Radiological Centre, Ministry of Health of Russia
| | | | - O. M. Pospelova
- Moscow Multidisciplinary Clinical Center “Kommunarka” of the Moscow Healthcare Department
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Does a tailored magnetic resonance imaging technique affect the surgical planning and outcomes for different cystic urethral and periurethral swellings in females? Seven years tertiary center experience. World J Urol 2022; 40:1587-1594. [PMID: 35296911 PMCID: PMC9166838 DOI: 10.1007/s00345-022-03973-w] [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: 01/14/2022] [Accepted: 02/21/2022] [Indexed: 10/28/2022] Open
Abstract
PURPOSE To evaluate the use of magnetic resonance imaging (MRI) in preoperative delineation and surgical planning for the management of female urethral and periurethral cystic vaginal swellings, with emphasis on postoperative surgical outcomes. MATERIALS AND METHODS This is a retrospective analysis of females complaining of periurethral and urethral cystic swellings referred to our tertiary center, who underwent MRI for preoperative planning in the period from January 2014 till January 2021, with a total number of 57 patients. Data retrieved from the medical records included: patients' demographics, presenting symptoms and signs, preoperative radiological investigations, duration of symptoms, previous surgical intervention, detailed intraoperative data, postoperative complications, and postoperative follow-up. RESULTS Urethral diverticulum was the commonest cystic lesion representing (64.9%) followed by Skene gland cysts in 14%, Mullerian cysts in 7%, Gartner cysts in 3.5%, and dermoid inclusion cysts in 10.5%. MRI precisely diagnosed the various pathological entities and anatomical complex lesions prior to surgery. This was confirmed after surgery and pathology analysis. All patients were followed up with a mean duration of 35 months, without any evidence of recurrence. CONCLUSION MRI as a standalone imaging technique is mandatory for diagnosis of all urethral and periurethral cystic lesions, as it offers the most accurate diagnostic modality for delineation of these lesions and hence aids in the preoperative surgical planning, aiming to avoid recurrence and improving surgical outcomes.
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Abstract
OBJECTIVE The aim of the study was to determine the effect of pregnancy on urethral rhabdosphincter cross-sectional area (CSA) and any association of CSA to urinary symptoms. METHODS Nulliparous women planning pregnancy (N = 135) underwent standardized evaluations (symptom and quality of life [QOL] questionnaires, magnetic resonance imaging, ultrasonography, and neurophysiologic testing) between January 2008 and December 2013 (V1). The participants who became pregnant and gave birth underwent the same evaluations at 6 weeks (V2) and 6 months postpartum (V3). Participants who had magnetic resonance imaging data from both V1 and V3 were selected. We measured urethral rhabdosphincter CSA from high-resolution axial MRIs in a masked fashion. The mean CSA for each participant was calculated. The change from V1 to V3 was assessed. RESULTS Sixty-eight women were evaluated. There was a significant decrease of 0.05 cm2 (interquartile range, -0.03 to 0.16 cm2; P = 0.002) in the median sphincter CSA between V1 and V3. There was a significant increase in the median Urinary Distress Inventory (UDI) subscore of the Pelvic Floor Distress Inventory (PFDI) from V1 to V3 (median increase of 0 [IQR, 0 to 8.3]; P = 0.033), but this was not significantly correlated with the change in the urethral CSA (Spearman correlation, 0.199; P = 0.107). Increasing fetal weight was correlated with a decrease in CSA postpartum after vaginal birth (Spearman correlation, -0.340; P = 0.017). CONCLUSIONS There is a decrease in urethral rhabdosphincter CSA with worsening Urinary Distress Inventory scores from prepregnancy to postpartum, but these two do not correlate in this cohort with low symptom levels. Among women who give birth vaginally, decrease in rhabdosphincter CSA is correlated with increasing fetal weight, perhaps with ramifications to be seen later in life.
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3D-Volume Rendering of the Pelvis with Emphasis on Paraurethral Structures Based on MRI Scans and Comparisons between 3D Slicer and OsiriX®. J Med Syst 2021; 45:27. [PMID: 33469726 PMCID: PMC7815623 DOI: 10.1007/s10916-020-01695-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/24/2020] [Indexed: 10/27/2022]
Abstract
The feasibility of rendering three dimensional (3D) pelvic models of vaginal, urethral and paraurethral lesions from 2D MRI has been demonstrated previously. To quantitatively compare 3D models using two different image processing applications: 3D Slicer and OsiriX. Secondary analysis and processing of five MRI scan based image sets from female patients aged 29-43 years old with vaginal or paraurethral lesions. Cross sectional image sets were used to create 3D models of the pelvic structures with 3D Slicer and OsiriX image processing applications. The linear dimensions of the models created using the two different methods were compared using Bland-Altman plots. The comparisons demonstrated good agreement between measurements from the two applications. The two data sets obtained from different image processing methods demonstrated good agreement. Both 3D Slicer and OsiriX can be used interchangeably and produce almost similar results. The clinical role of this investigation modality remains to be further evaluated.
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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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Abstract
Female urethral pathology can be challenging to diagnose clinically due to non-specific symptoms. High-resolution MRI has become a powerful tool in the diagnosis of urethral lesions and staging of malignancy. Additionally, dynamic MRI, fluoroscopy or ultrasound can evaluate for pelvic floor prolapse and the effectiveness of surgical interventions. This article will review the imaging features of common benign and malignant conditions of the female urethra including diverticula, benign cystic and solid lesions, malignancy, surgical slings, and injection of bulking agents.
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Choe J, Wortman JR, Sodickson AD, Khurana B, Uyeda JW. Imaging of Acute Conditions of the Perineum. Radiographics 2018; 38:1111-1130. [DOI: 10.1148/rg.2018170151] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Jihee Choe
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jeremy R. Wortman
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Aaron D. Sodickson
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Bharti Khurana
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
| | - Jennifer W. Uyeda
- From the Department of Radiology, Division of Emergency Radiology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115
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Asymptomatic Bartholin Cyst: Evaluation With Multidetector Row Computed Tomography. J Comput Assist Tomogr 2017; 42:162-166. [PMID: 28708722 DOI: 10.1097/rct.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine the frequency, morphology, and attenuation characteristics of Bartholin cysts on multidetector computed tomography (MDCT) in asymptomatic women. METHODS A total of 3280 consecutive MDCT examinations were assessed for Bartholin cysts. The diagnosis was based on shape, contrast enhancement, and anatomical location. Age, laterality, size, and attenuation patterns were recorded. Scans from patients with paravaginal-related symptoms were excluded, and any available follow-up MDCT scans or magnetic resonance images were evaluated. RESULTS Asymptomatic Bartholin cysts were seen in 17 patients (0.52%) (mean age, 56 years). The mean maximum cyst diameter was 21.8 mm. High-attenuation cysts comprised 47% of cases, all in older (≥50 years) patients. Follow-up MDCT scans showed minimal changes over time. CONCLUSIONS High-attenuation Bartholin cysts are more common than previously thought and are usually seen in older women. The size and attenuation of Bartholin cysts show only minimal changes over time.
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Preoperative 3D and 4D-CT imaging using 640-Multislice CT (640-MSCT) in diagnosis of female urethral diverticulum. World J Urol 2016; 35:1133-1139. [PMID: 27803968 PMCID: PMC5486543 DOI: 10.1007/s00345-016-1965-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/26/2016] [Indexed: 11/26/2022] Open
Abstract
Objective To determine the sensitivity and specificity of 640-Multislice CT (640-MSCT) in diagnosing the female UD. Materials and methods We investigated 16 patients with symptomatic UDs preoperatively in our hospital from August 2010 to March 2016. The patients’ average age was 38.8 years. All patients were performed 640-MSCT of pelvis; then, 3D and 4D images were reconstructed preoperatively. Results In 3D and 4D-CT images, out of 16 patients, thirteen patients had one ostium, two had 2 ostia and one had 3 ostia. Out of those thirteen patients, eight patients’ ostia were located at 5 o’clock and five patients’ at 7 o’clock. Patients with 2 ostia location were at 5 and 6 o’clock and 5 and 7 o’clock, respectively. Patients with 3 ostia location were at 5, 6 and 7 o’clock. The mean distance from the bladder neck to the ostia was 22.5 mm. The shape of UD was out-pouching in 11 patients (68.8%), U-shaped in four patients (25.0%) and circumferential in 1 patient (6.2%). The CT findings were confirmed by surgical findings. Conclusions 640-MSCT is a useful tool in identifying UD’s shape and ostium (including number, location) before operation. Preoperative 640-MSCT should be an adaptable modality for clinically suspected UD patients. Advances in knowledge Several imaging methods have been used to diagnose female UD. 640-MSCT may be more suitable to diagnose it for its higher sensitivity and specificity in diagnosis of female UD, especially in identifying UD’s shape and number and location of ostium.
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Deruyver Y, Hakim L, Franken J, De Ridder D. The use of imaging techniques in understanding lower urinary tract (dys)function. Auton Neurosci 2016; 200:11-20. [PMID: 27477680 DOI: 10.1016/j.autneu.2016.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 12/22/2015] [Accepted: 05/23/2016] [Indexed: 12/11/2022]
Abstract
The ability to store urine in the bladder and to void at an appropriate time depends on several complex mechanisms in the lower urinary tract (LUT) and its neural control. Normal LUT function requires coordination of the urinary bladder, urethra, pelvic floor, efferent and afferent neurons and specific spinal cord and brain areas. These structures can be visualised using different imaging modalities, such as ultrasound, X-ray and magnetic resonance imaging. The supraspinal neural control of the LUT can be studied using functional brain imaging. During the last two decades, the many technological improvements of these imaging techniques have increased our knowledge of voiding dysfunction. Here, we review the different imaging modalities of the LUT and its neural control and discuss their importance for diagnosing and understanding voiding dysfunction.
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Affiliation(s)
- Yves Deruyver
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lukman Hakim
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Airlangga University School of Medicine and Dr. Soetomo General Hospital, Department of Urology, Surabaya, Indonesia
| | - Jan Franken
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Laboratory of Experimental Urology, Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
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Abstract
Primary urethral carcinoma is a rare malignancy with an annual age-adjusted incidence rate of 1.5 per million in females in the U.S. The three main histologic subtypes include transitional-cell carcinoma, squamous-cell carcinoma, and adenocarcinoma. Of these, adenocarcinoma is the least common. Female urethral carcinomas are aggressive neoplasms with a generally poor prognosis. We report a case of the clear-cell variant of adenocarcinoma.
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Abstract
Skene’s glands are glands situated in the caudal two-thirds of the urethra. Infection of the gland by bacteria leads to inflammatory obstruction of the paraurethral ducts, causing the formation of a cyst or abscess. Patients typically present with dysuria, dyspareunia, vaginal discharge, and pain. On physical examination, a palpable mass is present and purulent material can be expressed from the ductal orifice. Clinical assessment of women with paraurethral gland symptoms is difficult, necessitating further evaluation with imaging. Recent advances in sonographic and magnetic resonance imaging have dramatically improved evaluation of the female urethra and the paraurethral glands, clarifying findings at physical examination and providing accurate road maps for surgeons. Even though magnetic resonance imaging is the gold standard, transperineal sonography is an emerging imaging technique that is being used to evaluate female urethral and periurethral disease in a more cost-effective manner.
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Affiliation(s)
- Rosemary Archer
- Department of Obstetrics and Gynaecology; Torbay Hospital; Torquay Devon TQ2 7AA UK
| | - Jennifer Blackman
- Department of Obstetrics and Gynaecology; Torbay Hospital; Torquay Devon TQ2 7AA UK
| | - Mark Stott
- Department of Urology; Royal Devon and Exeter Hospital; Exeter Devon EX2 5DW UK
| | - Julian Barrington
- Department of Obstetrics and Gynaecology; Torbay Hospital; Torquay Devon TQ2 7AA UK
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Tubay M, Hostetler V, Tujo C, Rezvani M, Shaaban A. Resident and fellow education feature: what is that cyst? Common cystic lesions of the female lower genitourinary tract. Radiographics 2015; 34:427-8. [PMID: 24617689 DOI: 10.1148/rg.342135086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Marc Tubay
- From the David Grant Medical Center USAF, Travis AFB, Calif (M.T., V.H., C.T.); University of Utah Health Sciences Center, Salt Lake City, Utah (M.T., M.R., A.S.); and Uniformed Services University of the Health Sciences, Bethesda, Md (M.T., C.T.)
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Abstract
Many urological studies rely on models of animals, such as rats and pigs, but their relation to the human urinary system is poorly understood. Here, we elucidate the hydrodynamics of urination across five orders of magnitude in body mass. Using high-speed videography and flow-rate measurement obtained at Zoo Atlanta, we discover that all mammals above 3 kg in weight empty their bladders over nearly constant duration of 21 ± 13 s. This feat is possible, because larger animals have longer urethras and thus, higher gravitational force and higher flow speed. Smaller mammals are challenged during urination by high viscous and capillary forces that limit their urine to single drops. Our findings reveal that the urethra is a flow-enhancing device, enabling the urinary system to be scaled up by a factor of 3,600 in volume without compromising its function. This study may help to diagnose urinary problems in animals as well as inspire the design of scalable hydrodynamic systems based on those in nature.
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Son JK, Taylor GA. Transperineal ultrasonography. Pediatr Radiol 2014; 44:193-201. [PMID: 24202431 DOI: 10.1007/s00247-013-2789-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Revised: 08/05/2013] [Accepted: 08/28/2013] [Indexed: 01/25/2023]
Abstract
Transperineal US has increased in use in the last decade. It is helpful in the evaluation of distal genitourinary structures, the rectum and overlying soft tissues. When used in conjunction with transabdominal US, transperineal US can further delineate anatomy and assess abnormalities that affect the lower pelvis. This paper describes optimal technique and common indications for transperineal US in children with examples of congenital and acquired lesions in pediatric patients.
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Affiliation(s)
- Jennifer K Son
- Department of Radiology, Boston Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA, 02115, USA
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Surabhi VR, Menias CO, George V, Siegel CL, Prasad SR. Magnetic Resonance Imaging of Female Urethral and Periurethral Disorders. Radiol Clin North Am 2013; 51:941-53. [DOI: 10.1016/j.rcl.2013.07.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Del Gaizo A, Silva AC, Lam-Himlin DM, Allen BC, Leyendecker J, Kawashima A. Magnetic resonance imaging of solid urethral and peri-urethral lesions. Insights Imaging 2013; 4:461-9. [PMID: 23686749 PMCID: PMC3731464 DOI: 10.1007/s13244-013-0259-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 04/25/2013] [Accepted: 04/29/2013] [Indexed: 01/26/2023] Open
Abstract
Solid urethral and peri-urethral lesions are rare and encompass benign and malignant aetiologies. A diagnosis without imaging is often challenging secondary to non-specific clinical symptoms and overlapping findings at the time of physical examination. Magnetic resonance (MR) imaging may be helpful in confirming a diagnosis while providing anatomical detail and delineating disease extent. This article reviews the normal MR anatomy of the male and female urethra, the MR appearance of solid primary and secondary urethral lesions, and the MR appearance of solid urethral lesion mimics. Teaching points • MRI is an important imaging technique in the evaluation of the spectrum of solid urethral lesions. • With excellent soft tissue resolution, MR is accurate in staging primary urethral carcinoma. • Disruption of the zonal anatomy of the female urethral wall indicates peri-urethral extension. • Be aware of benign urethral lesions, particularly those that may mimic solid urethral masses.
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Affiliation(s)
- Andrew Del Gaizo
- Department of Radiology, Wake Forest University, Medical Center Blvd., Winston-Salem, NC, 27157, USA,
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22
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Hosseinzadeh K, Heller MT, Houshmand G. Imaging of the Female Perineum in Adults. Radiographics 2012; 32:E129-68. [DOI: 10.1148/rg.324115134] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Salvador Álvarez E, Alvarez Moreno E, Jiménez de la Peña M, Recio Rodríguez M. [Malignant degeneration in a urethral diverticulum: an uncommon complication in a common condition]. RADIOLOGIA 2011; 53:266-9. [PMID: 21295803 DOI: 10.1016/j.rx.2010.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 06/13/2010] [Accepted: 06/15/2010] [Indexed: 11/26/2022]
Abstract
Acquired urethral diverticula are relatively common in women. They are usually asymptomatic but they can lead to complications; infection and stones are the most common complications. Malignant degeneration with the development of a malignant tumor in the diverticulum is a rare complication that must be taken into account. Few cases of malignant tumors in urethral diverticula have been reported. We present the case of a woman diagnosed with a malignant tumor in a urethral diverticulum. We review the imaging findings for urethral diverticula and the complications that can arise in this condition.
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Affiliation(s)
- E Salvador Álvarez
- Servicio de Radiodiagnóstico, Hospital Universitario Doce de Octubre, Madrid, España.
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Chaudhari VV, Patel MK, Douek M, Raman SS. MR Imaging and US of Female Urethral and Periurethral Disease. Radiographics 2010; 30:1857-74. [DOI: 10.1148/rg.307105054] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Libby B, Chao D, Schneider BF. Non-surgical treatment of primary female urethral cancer. Rare Tumors 2010; 2:e55. [PMID: 21139970 PMCID: PMC2994528 DOI: 10.4081/rt.2010.e55] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 08/19/2010] [Indexed: 11/25/2022] Open
Abstract
Primary carcinomas of the female urethra are extremely rare, with an annual incidence of less than ten in one million. Currently, there is no consensus regarding management of this malignancy. However, there have been several case reports demonstrating the efficacy of chemoradiation in the treatment of female urethral cancer. In this report we present two cases of female primary urethral adenocarcinoma that were treated by concomitant chemotherapy and external beam radiotherapy, followed by interstitial brachytherapy.
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Goss J. Evaluation of Urethra and Anterior Wall Vaginal Leiomyoma by Translabial/Transurethral Sonography. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2009. [DOI: 10.1177/8756479309346447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Recent advances in sonography have dramatically improved the evaluation of the female urethra and vaginal canal. Widespread use of sonography for the detection of vaginal masses presents a less expensive way to identify pathology. The author recently encountered a patient with a rare vaginal mass. The following case illustrates translabial and transurethral sonography defining a vaginal mass directly under the urethra with no urethra luminal abnormalities. In general, the identification of a vaginal mass would lead most physicians to consider magnetic resonance imaging for characterization. Sonography presents an opportunity to provide accurate information without increasing medical cost to the patient. To the author’s knowledge, this is the first report describing translabial and transurethral sonography using a 10-MHz linear transducer to determine extension of a tumor from the vaginal wall into the lumen of the urethra.
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Affiliation(s)
- Julie Goss
- Frank R. Howard Memorial Hospital, Willits, California,
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Lima CMADO, Coutinho EPD, Ribeiro ÉB, Domingues MNA, Junqueira FP, Coutinho Junior AC. Ressonância magnética na endometriose do trato urinário baixo: ensaio iconográfico. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000300013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Endometriose é definida como a presença de tecido endometrial funcionante fora da cavidade endometrial e do miométrio. É uma doença comum, de causas multifatoriais, porém o envolvimento do trato urinário baixo é raro. A ressonância magnética tem elevada sensibilidade, especificidade e acurácia no diagnóstico da endometriose do trato geniturinário baixo, principalmente por permitir a identificação das lesões de permeio a aderências e a avaliação da extensão das lesões subperitoneais. Neste estudo são ilustrados, sob a forma de ensaio iconográfico, os principais achados à ressonância magnética do envolvimento por endometriose do trato urinário baixo.
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Affiliation(s)
| | - Elisa Pompeu Dias Coutinho
- Clínicas de Diagnóstico Por Imagem (CDPI) e Multi-Imagem; Centro de Diagnóstico por Imagem Fátima Digittal, Brasil
| | - Érica Barreiros Ribeiro
- Clínicas de Diagnóstico Por Imagem (CDPI) e Multi-Imagem; Centro de Diagnóstico por Imagem Fátima Digittal, Brasil
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El-Zein C, Khoury N, El-Zein Y, Bulbul M, Birjawi G. Intraoperative translabial ultrasound for urethral diverticula: A road map for surgeons. Eur J Radiol 2009; 70:133-7. [DOI: 10.1016/j.ejrad.2007.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2007] [Revised: 12/18/2007] [Accepted: 12/19/2007] [Indexed: 11/28/2022]
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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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Digesu GA, Khullar V. Re: Michael Mitterberger, Germar-Michael Pinggera, Rainer Marksteiner, et al. Adult stem cell therapy of female stress urinary incontinence. Eur Urol 2008;53:169-75. Eur Urol 2008; 55:e23-4. [PMID: 18433983 DOI: 10.1016/j.eururo.2008.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2008] [Accepted: 04/04/2008] [Indexed: 10/22/2022]
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Lang EK, Sethi E, Ordonez A, Colon I, Macchia R. Adenocarcinoma of suburethral diverticulum. J Urol 2007; 179:728. [PMID: 18082826 DOI: 10.1016/j.juro.2007.10.101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Erich K Lang
- Department of Radiology, SUNY, Downstate Medical School, Brooklyn, New York, USA
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Strasser H, Marksteiner R, Margreiter E, Pinggera GM, Mitterberger M, Frauscher F, Ulmer H, Fussenegger M, Kofler K, Bartsch G. Autologous myoblasts and fibroblasts versus collagen for treatment of stress urinary incontinence in women: a randomised controlled trial. Lancet 2007; 369:2179-2186. [PMID: 17604800 DOI: 10.1016/s0140-6736(07)61014-9] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Preclinical studies have suggested that transurethral injections of autologous myoblasts can aid in regeneration of the rhabdosphincter, and fibroblasts in reconstruction of the urethral submucosa. We aimed to compare the effectiveness and tolerability of ultrasonography-guided injections of autologous cells with those of endoscopic injections of collagen for stress incontinence. METHODS Between 2002 and 2004, we recruited 63 eligible women with urinary stress incontinence. 42 of these women were randomly assigned to receive transurethral ultrasonography-guided injections of autologous myoblasts and fibroblasts, and 21 to receive conventional endoscopic injections of collagen. The first primary outcome measure was an incontinence score (range 0-6) based on a 24-hour voiding diary, a 24-hour pad test, and a patient questionnaire. The other primary outcome measures were contractility of the rhabdosphincter and thickness of both the urethra and rhabdosphincter. Analysis was by intention to treat. This trial is registered with Controlled-Trials.com, number CCT-NAPN-16630. FINDINGS At 12-months' follow-up, 38 of the 42 women injected with autologous cells were completely continent, compared with two of the 21 patients given conventional treatment with collagen. The median incontinence score decreased from a baseline of 6.0 (IQR 6.0-6.0; where 6 represents complete incontinence), to 0 (0-0) for patients treated with autologous cells, and 6.0 (3.5-6.0) for patients treated with collagen (p<0.0001). Ultrasonographic measurements showed that the mean thickness of the rhabdosphincter increased from a baseline of 2.13 mm (SD 0.39) for all patients to 3.38 mm (0.26) for patients treated with autologous cells and 2.32 mm (0.44) for patients treated with collagen (p<0.0001). Contractility of the rhabdosphincter increased from a baseline of 0.58 mm (SD 0.32) to 1.56 mm (0.28) for patients treated with autologous cells and 0.67 mm (0.51) for controls (p<0.0001). The change in the thickness of the urethra after treatment was not significantly different between treatment groups. No adverse effects were recorded in any of the 63 patients. INTERPRETATION Long-term postoperative results and data from multicentre trials with larger numbers of patients are needed to assess whether injection of autologous cells into the rhabdosphincter and the urethra could become a standard treatment for urinary incontinence.
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Affiliation(s)
| | - Rainer Marksteiner
- Institute for Biochemical Pharmacology, University of Innsbruck, Austria
| | - Eva Margreiter
- Institute for Biochemical Pharmacology, University of Innsbruck, Austria
| | | | | | | | - Hanno Ulmer
- Department of Medical Statistics, Informatics, and Health Economy, University of Innsbruck, Austria
| | - Martin Fussenegger
- Department of Otolaryngology, Sisters of Charity Hospital, Wels, Austria
| | - Kurt Kofler
- Department of Urology, University of Innsbruck, Austria
| | - Georg Bartsch
- Department of Urology, University of Innsbruck, Austria
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Lucioni A, Rapp DE, Gong EM, Fedunok P, Bales GT. Diagnosis and management of periurethral cysts. Urol Int 2007; 78:121-5. [PMID: 17293650 DOI: 10.1159/000098068] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Accepted: 06/28/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Periurethral cysts are a rare entity that may be confused with urethral diverticula. The protocol for diagnosis and management of these lesions is still unclear. We present our experience with six patients presenting with periurethral cysts. METHODS From 2001 to 2005 we evaluated six patients with a paraurethral mass. History, physical examination, laboratory and radiographic findings were analyzed to determine factors helpful in mass diagnosis. Cyst excision was performed via trans-vaginal approach in all patients and outcomes of this approach were assessed. RESULTS Six female patients, average age of 29.7 years, presented with the complaint of a paraurethral mass. Transvaginal sonography was performed in two patients to confirm the presence of a periurethral cyst. Cystourethroscopy in all patients revealed no communication between the cyst and the urethra or presence of other lesions. Pathology revealed a benign cyst in all patients. No cyst recurrence has been seen in any patient. CONCLUSION Most periurethral cysts can be diagnosed by physical examination. The diagnosis may be confirmed with transvaginal sonography. Cystourethroscopy should be performed to rule out other pathology, but may be done in the same setting as surgical excision. Complete surgical excision is effective and is associated with minimal risk of recurrence during short-term follow-up.
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Affiliation(s)
- Alvaro Lucioni
- Section of Urology, Department of Surgery, University of Chicago, Chicago, Ill. 60637, USA
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38
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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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Abstract
MR provides excellent depiction of the female pelvic anatomy and has become the imaging modality of choice for the accurate diagnosis of numerous benign gynecologic conditions. Detection and characterization of leiomyomata and adenomyosis is performed routinely at many centers, and MR plays an important role in stratifying patients into appropriate treatment options. MR imaging is also uniquely well suited to the evaluation of gynecologic conditions that occur during pregnancy and in the postpartum period. This article describes MR protocols and the typical findings of various benign conditions of the uterine corpus and cervix, including congenital anomalies, leiomyomas, adenomyosis, and complications related to pregnancy.
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Affiliation(s)
- Michèle A Brown
- Department of Radiology, University of California, San Diego Medical Center, 200 West Arbor Drive, San Diego, CA 92103, USA.
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Bibliography. Current world literature. Female urology. Curr Opin Urol 2006; 16:310-3. [PMID: 16770134 DOI: 10.1097/01.mou.0000232056.97213.e8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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