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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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Hermans L, Borde‐Doré L, Drumond B, Cadoré J. Urethral diverticula in a 26‐year‐old gelding: A unique case report. EQUINE VET EDUC 2023. [DOI: 10.1111/eve.13781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
| | - Laura Borde‐Doré
- Equine Department, VetAgro Sup University of Lyon Marcy l'Etoile France
| | - Bianca Drumond
- Equine Department, VetAgro Sup University of Lyon Marcy l'Etoile France
| | - Jean‐Luc Cadoré
- Equine Department, VetAgro Sup University of Lyon Marcy l'Etoile France
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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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Nic an Ríogh AU, Monagas Arteaga S, Tzelves L, Karavitakis M, Nambiar AK. Female Urethral Diverticula: a Contemporary Narrative Review of Aetiology, Diagnosis, and Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00666-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Abstract
OBJECTIVE Urethral diverticulum is a rare, yet important condition for the female pelvic surgeon. We aimed to characterize the women who have been seen for this condition across the three Mayo Clinic locations. METHODS Medical record review was performed for patients across all three Mayo Clinic sites (Rochester, Arizona, Florida) that had International Classification of Diseases, Ninth Revision, (ICD-9) and International Classification of Diseases, Tenth Revision, (ICD-10) codes corresponding to urethral diverticulum (ICD-9, 599.2; ICD-10, N36.1). We also performed a review of patients who underwent urethral diverticulectomy via Current Procedural Terminology (CPT) code 53235. Data were available for patients from June 1, 2003, to October 5, 2018. Patients were classified by age, etiology, presenting symptomatology, location, treatment, pathology, and postoperative outcomes. RESULTS Four hundred forty-seven women met initial coding criteria for urethral diverticula, with 228 women having documented urethral diverticula. The most common presentations were irritative voiding symptoms (93) and infections (92). The most common diagnostic modality was radiographic imaging (198/228) with magnetic resonance imaging accounting for 157 cases. Etiology was unknown in the majority of cases (181/228). Of women who were diagnosed, 172 underwent diverticulectomy with 51 concurrent urethral sling placements. Final pathology demonstrated 2 cases of malignancy. Postoperative follow-up ranged from 0 months to 15 years (mean, 1.4 years; median, 4 months). Forty-three patients had persistent urinary symptoms after diverticulectomy with stress incontinence being the most common. Eight patients underwent subsequent sling placement. Fourteen patients had recurrence. CONCLUSIONS This appears to be the largest reported series on female urethral diverticula, a rare yet important entity that requires special consideration. Most surgical cases found resolution of symptoms after diverticulectomy. Importantly, less than 2% of urethral diverticula were associated with malignancy.
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Kania LM, Guglielmo F, Mitchell D. Interpreting body MRI cases: classic findings in pelvic MRI. Abdom Radiol (NY) 2020; 45:2916-2930. [PMID: 32607649 DOI: 10.1007/s00261-020-02615-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 06/03/2020] [Accepted: 06/11/2020] [Indexed: 12/31/2022]
Abstract
The high contrast resolution provided by magnetic resonance imaging (MRI) compared to all other modalities allows the interpreting radiologist to make a specific diagnosis for many common and uncommon findings. In some cases, the diagnosis can be so certain that there is no differential diagnosis. In this article, we review the most classically recognized findings when interpreting MRI of the pelvis including the following: Ovaries: Simple cyst, hemorrhagic cyst, corpus luteum, dermoid, fibroma/fibrothecoma. Uterus: C-section scar, adenomyosis, endometriosis, fibroid, congenital uterine anomalies. Cervix: nabothian cyst, cervical cancer. Vagina/Vulva: Gardener's duct cyst, Bartholin's gland cyst. Urethra: skene gland cyst, urethral diverticulum. Prostate: utricle cyst, Mullerian duct cyst, benign prostatic hyperplasia, prostate cancer.
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Jung C, Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric 2019; 22:242-249. [PMID: 30624087 PMCID: PMC6629580 DOI: 10.1080/13697137.2018.1551871] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/17/2018] [Indexed: 01/17/2023]
Abstract
Urinary tract infections (UTIs) are one of the most common infections and affect up to 50% of women in their lifetime, with almost half of these women experiencing a recurrence in 6-12 months. Menopause predisposes women to recurrent UTI (rUTI), as normally lower levels of estrogen lead to changes in the urogenital epithelium and subsequently urogenital microbiome. The recently discovered urobiome is now known to have different compositions in both healthy and unhealthy bladders, including a role in the pathophysiology of rUTI, and may be a therapeutic target for prevention and treatment options for rUTI. In postmenopausal women with frequent UTI, the diagnosis of acute UTI should be made using a combination of the symptom assessment and urine diagnostic studies. The choice of UTI antibiotic should include consideration of efficacy, collateral effects, and side-effects. Some women may be candidates for self-start therapy, in which the patient accurately recognizes her UTI symptoms and then starts previously prescribed antibiotics. A large component of the management of women with rUTI is prevention. Urobiome research for bladder health and disease is a young field of investigation with significant potential to improve care for postmenopausal women affected by rUTI through novel, evidence-based prevention and treatment strategies.
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Affiliation(s)
- Carrie Jung
- a Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery , University of California San Diego , La Jolla , CA , USA
| | - Linda Brubaker
- a Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Female Pelvic Medicine and Reconstructive Surgery , University of California San Diego , La Jolla , CA , USA
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Abstract
Objective: To present a review of the current literature regarding the presentation, diagnosis, and treatment of female urethral diverticula (UD). Methods: A systematic search of the PubMed database was performed to identify studies evaluating female UD. Article titles, abstracts and full-text manuscripts were screened to identify relevant studies, which then underwent data extraction and analysis. Results: In all, 50 studies evaluating the presentation, diagnosis and treatment of female UD were deemed relevant for inclusion. Almost all studies were retrospective single-arm case series. Female UD are outpouchings of the urethral lumen into the surrounding connective tissue. The presentation of female UD is diverse and can range from incidental findings to lower urinary tract symptoms, frequent urinary tract infections, dyspareunia, urinary incontinence (UI), or malignancy. Repair of UD begins with an accurate assessment and diagnosis, which should include adequate radiographic imaging, usually including magnetic resonance imaging. Once the diagnosis is confirmed, the usual treatment is surgical excision and reconstruction, most often through a transvaginal approach. The principles of transvaginal urethral diverticulectomy include: removal of the entire urethral diverticulum wall, watertight closure of the urethra, multi-layered and non-overlapping closure of surrounding tissue with absorbable suture, and preservation or creation of continence. Results of surgical repair are usually excellent, although long-term recurrence of these lesions may occur. Complications of urethral diverticulectomy include urethrovaginal fistula, UI, and rarely urethral stricture. Conclusion: Whilst urethral diverticulectomy excision and reconstruction is a challenging procedure, it is ultimately satisfying for the patient and the surgeon when relief of bothersome symptoms is achieved. Adherence to principles of reconstructive surgery is important to ensure a satisfactory result. Abbreviations: PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; UD: urethral diverticulum/diverticula; UI: urinary incontinence; US: ultrasonography; VCUG: voiding cystourethrogram
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Affiliation(s)
- Alyssa K Greiman
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Jennifer Rolef
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
| | - Eric S Rovner
- Department of Urology, Medical University of South Carolina, Charleston, SC, USA
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Carswell FM. Urethral diverticulum in pregnancy: a case report. Int Urogynecol J 2019; 30:2149-2151. [PMID: 30879101 DOI: 10.1007/s00192-019-03890-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 01/25/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urethral diverticulum in pregnancy is a rare finding and difficult to diagnose. The classical triad of dysuria, dyspareunia and dribbling of urine is found in a minority of women. METHODS A young woman presented during the first trimester of pregnancy with vaginal and suprapubic pain as well as voiding difficulty. Ultrasound demonstrated a 2-cm hypoechoic lesion to the left of the urethra. She went on to have a cystoscopy that demonstrated a diverticulum. She was found to have chlamydia on PCR. RESULTS Her pregnancy was complicated by recurrent admissions for pain and also an episode of reactive arthritis. She underwent an uncomplicated surgical excision postpartum. CONCLUSIONS Urethral diverticula should be excluded whenever a patient exhibits unresolved, nonspecific urinary problems. This is an underdiagnosed problem. Pregnancy presents additional challenges, but does not preclude medical or surgical treatment in the patient with significant symptoms.
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Affiliation(s)
- Frida M Carswell
- Department of Obstetrics and Gynaecology, Maitland Hospital, Maitland, NSW, Australia.
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Cruz J, Figueiredo F, Matos AP, Duarte S, Guerra A, Ramalho M. Infectious and Inflammatory Diseases of the Urinary Tract: Role of MR Imaging. Magn Reson Imaging Clin N Am 2018; 27:59-75. [PMID: 30466913 DOI: 10.1016/j.mric.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Urinary tract infection (UTI) is among the most common of bacterial infections. Imaging studies are only required in cases of complicated UTIs. Ultrasound remains the first-line imaging method; however, CT is the gold standard for evaluation of UTIs. MR imaging's improved contrast resolution and absence of ionizing radiation may recommend its use for assessment of lower UTIs. Furthermore, MR imaging performs with diagnostic accuracy at least similar to CT in complicated UTIs, except for the identification of calculi and emphysematous pyelonephritis. In this article, the role of MR imaging for the evaluation of infectious and inflammatory disease processes of the urinary tract is reviewed.
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Affiliation(s)
- João Cruz
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal; Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal
| | - Filipa Figueiredo
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - Sérgio Duarte
- Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal
| | - Adalgisa Guerra
- Department of Radiology, Hospital da Luz, Avenida Lusíada, 100, Lisbon 1500-650, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal; Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal.
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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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Queiroz RM, Costa PPE, de Oliveira NYF, Paron JA, Febronio EM. Female urethral diverticulum containing a urothelial carcinoma. Radiol Bras 2017; 49:406-407. [PMID: 28057968 PMCID: PMC5210038 DOI: 10.1590/0100-3984.2015.0115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023] Open
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Three-Dimensional Imaging of Urethral Stricture Disease and Urethral Pathology for Operative Planning. Curr Urol Rep 2016; 17:54. [PMID: 27278565 DOI: 10.1007/s11934-016-0616-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Diagnosing urethral pathology can prove difficult, as clinically, the presentation is often nonspecific and may be suggestive of multiple etiologies. Therefore, detailed and accurate urethral imaging in both males and females is critical. Since the early 1900s, conventional imaging studies including RUG and VCUG, with adjunct cystourethroscopy, have remained the gold standard diagnostic techniques to evaluate urethral pathology. However, limitations of conventional imaging have generated interest in finding alternative imaging modalities with comparable, if not superior, diagnostic accuracy, the goal being a more complete assessment of urethral pathology and anatomy that would allow for appropriate surgical planning. Imaging modalities with three-dimensional (3D) capabilities may provide more comprehensive information regarding urethral diseases through a more detailed illustration of periurethral soft tissue structures. Whether or not these imaging modalities will replace conventional studies is unclear, though there is an increasing body of literature that support their use.
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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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Nishisho T, Takao S, Miyagi R, Toki S, Nagamachi A, Sairyo K. Complete spontaneous regression of a subpubic cartilaginous cyst: a case report. THE JOURNAL OF MEDICAL INVESTIGATION 2016; 63:319-22. [PMID: 27644580 DOI: 10.2152/jmi.63.319] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Subpubic cartilaginous cyst was recently reported as a rare degenerative mass on the pubic symphysis. We report here a 59-year-old woman who presented with a vulvar mass that showed complete spontaneous regression 48 months after the initial visit. Treatment was only wearing brace. This is the first report of complete spontaneous regression of a subpubic cartilaginous cyst. In the case of small subpubic cyst, observation and follow-up alone may be sufficient. J. Med. Invest. 63: 319-322, August, 2016.
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Affiliation(s)
- Toshihiko Nishisho
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School
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Urethral Diverticulum in Women: Retrospective Case Series. J Obstet Gynaecol India 2016; 66:47-51. [PMID: 26924907 DOI: 10.1007/s13224-014-0642-0] [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: 08/13/2014] [Accepted: 10/28/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE We present the management of 17 cases of urethral diverticulum in our department. We describe the various clinical presentations of urethral diverticulum, which may mimic other pelvic floor disorders and result in diagnostic delay. MATERIALS AND METHODS We reviewed 17 cases of urethral diverticulum presented to the urogynaecology department between January 2006 and February 2011 retrospectively. Patient demographics, history, clinical evaluation, diagnostic modalities, and management plans were reviewed. All of them underwent Magnetic Resonance Imaging (MRI) prior to the procedure. RESULTS The mean time from onset of symptoms to diagnosis of a urethral diverticulum was 24 ± 5.6 months. MRI identified the urethral diverticulum in all cases while voiding cystourethrography confirmed the diagnosis in 4 (23.5 %). They have been divided into two groups: Group A, (4-6 mm largest axis range) 5 (29.41 %) cases; Group B, (6-33 mm largest axis range) 12(70.59 %). All in Group A were symptomatic with recurrent Urinary Tract Infection (UTI), whereas only 8 (66.6 %) in Group B were symptomatic. Transvaginal diverticulectomy was done in 12 women who were symptomatic (70.5 %). Postoperative evaluation revealed complete resolution of symptoms, such as recurrent UTI, dysuria, and dyspareunia. One patient was unsure of surgery, while conservative approach was opted for asymptomatic patients 4 (23.5 %). The use of preoperative MRI altered the management in 2 (11.7 %) women. CONCLUSION The diagnosis of urethral diverticulum should be considered in women with recurrent UTI, dysuria, dyspareunia, and irritative voiding symptoms not responding to conservative therapy.
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Kaur G, Jain S, Sharma A, Suneja A, Guleria K. Urethral Diverticulum Masquerading as Anterior Vaginal Wall Cyst: A Diagnostic Dilemma. J Clin Diagn Res 2015; 9:QD08-9. [PMID: 26557574 DOI: 10.7860/jcdr/2015/13187.6636] [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] [Received: 01/23/2015] [Accepted: 08/03/2015] [Indexed: 11/24/2022]
Abstract
Urethral diverticulum (UD) is a condition in which a variably sized outpouching forms, next to the urethra. Because it connects to the urethra, this outpouching repeatedly gets filled with urine during micturition, thus causing symptoms. In females, it presents as a bulge in anterior vagina, mimicking a vaginal wall cyst. Various aetiologies proposed attributing to urethral diverticulum formation is repeated infection of the periurethral gland, childbirth trauma, iatrogenic and urethral instrumentation. Patients of UD present with non specific irritative lower urinary tract symptoms such as increased frequency, urgency and dysuria; symptoms may not correlate with the size of the diverticulum. Recurrent cystitis or urinary tract infection is seen in one-third of patients. Pain, hematuria, post-void dribbling, dyspareunia, urinary retention or incontinence is other symptoms. In some cases, there may be associated urethral calculi or carcinoma. Magnetic resonance imaging (MRI) is highly sensitive and specific for the diagnosis of UD, although non invasive sonography may be the first line investigation. Treatment is by transvaginal diverticulectomy or marsupialization. A 60-year-old P9L6 postmenopausal lady, presented with a tender, hard suburethral anterior vaginal wall mass. Cystourethroscopy revealed a small opening in posterior urethra, with stone visible through it. With the final diagnosis of suburethral diverticulum with retained multiple calculi, excision of the diverticulum and repair of urethra was done vaginally. Correct evaluation and treatment of this condition can lead to avoidance of urinary tract injury.
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Affiliation(s)
- Gurpreet Kaur
- Senior Resident, Department of Obstetrics and Gynaecology, Delhi State Cancer Institute (DSCI) , Delhi, India
| | - Sandhya Jain
- Assistant Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital , Delhi, India
| | - Abha Sharma
- Specialist, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital , Delhi, India
| | - Amita Suneja
- Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital , Delhi, India
| | - Kiran Guleria
- Professor, Department of Obstetrics and Gynaecology, UCMS and GTB Hospital , Delhi, India
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Abstract
Female urethral diverticula are rare, benign epithelium-lined outpouchings of the female urethra. Patients can present with a multitude of symptoms, most commonly urinary incontinence, recurrent UTIs and dyspareunia. These presenting symptoms are often confused with other diagnoses leading to delayed diagnosis or misdiagnosis. Diagnosis and preoperative assessment of bladder function is most accurate using a combination of clinical examination, T2-weighted postvoid MRI and videocystometrography. Best treatment is by vaginal excision, a procedure with a very low recurrence rate and high patient acceptability. Excision also results in high cure rates for associated dyspareunia, UTI and voiding dysfunction. Pre-existing urodynamically proven stress urinary incontinence (USUI) resolves in 50% of patients after excision of the diverticulum with Martius labial fat pad interposition without the need for further treatment. Potential adverse effects after surgery are new-onset USUI, urethrovaginal fistula and urethral stricture. The rate of onset of these potential adverse effects is low and related to the preoperative appearance of the diverticulum on an MRI scan and the complexity of the diverticulum.
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Affiliation(s)
- Tamsin J Greenwell
- Department of Urology, University College London Hospital, Ground Floor North, 250 Euston Road, London NW1 2PG, UK
| | - Marco Spilotros
- Department of Urology, University College London Hospital, Ground Floor North, 250 Euston Road, London NW1 2PG, UK
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Lee YJ, Son SJ, Paick JS, Kim SW. Preoperative CT voiding cystourethrography using 16-multidetector CT in female urethral diverticulum. PLoS One 2014; 9:e107448. [PMID: 25216189 PMCID: PMC4162593 DOI: 10.1371/journal.pone.0107448] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/11/2014] [Indexed: 11/27/2022] Open
Abstract
Purpose To evaluate the clinical usefulness of preoperative CT voiding cystourethrography (CT-VCUG) using 16-multidetector computed tomography for female urethral diverticula. Materials and Methods Preoperative CT-VCUG was performed in 15 consecutive patients who underwent urethral diverticulectomy from May 2004 to December 2012. The result of preoperative cystourethroscopy and surgical findings were recorded by a single surgeon and CT-VCUG findings including the location of osita were retrospectively reviewed by another urologist who was blinded to the surgical finding. The location of the ostium detected on CT-VCUG was compared descriptively with the intraoperative surgical and preoperative cystourethroscopic findings. Results A total of 14 consecutive patients who underwent preoperative CT-VCUG and urethral diverticulectomy were included in the analysis. Ostia were detected on CT-VCUG in all cases, whereas ostia were identified in 10 patients (71.4%) by cystourethroscopy. Ostia were located between the 4 and 8 o’clock direction. Mean distance from the bladder neck to the ostium was 24.2 mm. Circumferential and horseshoe shaped diverticula were observed in 6 and 4 patients, respectively. The surgical findings correlated well with the CT findings. Conclusions Preoperative CT-VCUG can be useful in identifying the ostia of urethral diverticula in patients scheduled for urethral diverticulectomy and can provide structural information, useful to establish surgical strategy.
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Affiliation(s)
- Young Ju Lee
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Seung Jun Son
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Jae-Seung Paick
- Department of Urology, Seoul National University Hospital, Seoul, Korea
| | - Soo Woong Kim
- Department of Urology, Seoul National University Hospital, Seoul, Korea
- * E-mail:
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Urethritis in Women—Considerations Beyond Urinary Tract Infection. CURRENT BLADDER DYSFUNCTION REPORTS 2014. [DOI: 10.1007/s11884-014-0246-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Chronic Lower Urinary Tract Symptoms in Women: Classification of Abnormalities and Value of Dedicated MRI for Diagnosis. AJR Am J Roentgenol 2014; 202:W59-66. [DOI: 10.2214/ajr.13.10681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Correlation between MRI and double-balloon urethrography findings in the diagnosis of female periurethral lesions. Eur J Radiol 2013; 82:2183-8. [DOI: 10.1016/j.ejrad.2013.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2013] [Revised: 07/12/2013] [Accepted: 08/01/2013] [Indexed: 11/22/2022]
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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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Singla P, Long SS, Long CM, Genadry RR, Macura KJ. Imaging of the female urethral diverticulum. Clin Radiol 2013; 68:e418-25. [PMID: 23561897 DOI: 10.1016/j.crad.2013.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 02/04/2013] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
Abstract
Female urethral diverticulum is a localized out-pouching of the urethra that is becoming increasingly prevalent, but often poses a diagnostic challenge. Traditionally, conventional voiding cystourethrography has been used to make the preoperative diagnosis. With the development of higher-resolution images acquired through ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), the anatomy and various abnormalities of the female urethra can be better elucidated. This article focuses on the imaging features of female urethral diverticulum, with emphasis on diagnostic pearls, particularly using MRI. Female urethral diverticulum can be best identified by their location in the posterolateral urethra and by their communication with the urethral lumen. Improved imaging techniques combined with increased physician awareness of urethral diverticulum will lead to more prompt and accurate diagnosis of this entity, leading to better treatment of affected patients.
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Affiliation(s)
- P Singla
- Brody School of Medicine, East Carolina University, Greenville, NC, USA
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Dai Y, Wang J, Shen H, Zhao RN, Li YZ. Diagnosis of female urethral diverticulum using transvaginal contrast-enhanced sonourethrography. Int Urogynecol J 2013; 24:1467-71. [PMID: 23371286 DOI: 10.1007/s00192-012-2036-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 12/22/2012] [Indexed: 02/05/2023]
Abstract
INTRODUCTION AND HYPOTHESIS This study investigated the value of transvaginal contrast-enhanced sonourethrography for the diagnosis of female urethral diverticulum (UD) by comparing results of contrast-enhanced ultrasound images and surgical findings. METHODS A total of 14 female UD patients underwent preoperative transvaginal contrast-enhanced sonourethrography between July 2010 and June 2012. History and physical examination were initially assessed by the same urologist. Transvaginal contrast-enhanced ultrasound imaging was performed and interpreted by the same ultrasonographer. Definite diagnosis was made by tracking the flow of the microbubbles into the cyst. Additionally, sagittal, cross-sectional, and dynamic images were obtained, and color Doppler ultrasound was applied in all cases. Data on the size, location, configuration, and opening of the UD was documented, and then compared with the surgical findings. RESULTS The most common symptoms presenting in the UD patients included urinary incontinence (71.5 %), recurrent urinary tract infection (57.1 %), frequency (50 %), urgency (35.7 %), dysuria (35.7 %), and dyspareunia (21.4 %). On physical examination, 8 out of 14 patients (57.1 %) had a palpable anterior vaginal wall mass, while 6 out of 14 patients (42.9 %) had no palpable mass. Transvaginal contrast-enhanced sonourethrography revealed 17 diverticula orifices in total and correlated well with surgical findings regarding the size, location, configuration, and the opening of the UD. CONCLUSIONS In patients with chronic irritative bladder symptoms, but with no response to conventional treatment a high index of suspicion for UD should be maintained. Our study demonstrates that transvaginal contrast-enhanced sonourethrography is a useful tool for defining the size, location, configuration, and opening of the UD before surgery.
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Affiliation(s)
- Yi Dai
- Department of Urology, West China Hospital, Sichuan University, No. 37 Guoxuexiang Street, Chengdu, 610041, China
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