Diagnosis of female urethral diverticulum using pelvic floor ultrasound and comparison with voiding cystourethrogram (imaging study).

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.

Female Urethral Reconstruction: Urethral Diverticulectomy, Urethral Strictures, Vesicovaginal Fistula.

Urethral reconstruction in women encompasses a variety of different entities including female urethral stricture, female urethral diverticulum, and vesicovaginal fistula. Although very different in their causes, they all have in common a vague and nonspecific onset of symptoms and, usually, a delayed diagnosis. Once identified and evaluated, urologists must review the management options with the patient, which range from minimally invasive procedures to complex reconstructive surgeries. In complicated cases, we recommend referral to an experienced specialized center for definitive management.

Correlation between symptoms and imaging findings including pelvic floor ultrasound to improve the symptom-based diagnosis of female urethral diverticulum (CHECK-UD study).

INTRODUCTION AND HYPOTHESIS: The objective was to establish a model to predict the presence of a female urethral diverticulum (UD) based on symptoms. METHODS: A prospective CHECK-UD study (check of female urethral diverticulum) was conducted. Female patients presenting with symptoms such as lower urinary tract symptoms (LUTS), postmicturition dribble or urinary incontinence (UI), dyspareunia or pain in the pelvic area, and recurrent urinary tract infection (UTI) treated between 2015 and 2020 were included. The association between each symptom variable and the positive finding of UD was evaluated by multivariate logistic regression adjusting for age, body mass index (BMI), vaginal deliveries, previous surgery for SUI, previous pelvic surgery, and microscopic hematuria. A predictive model for the presence of UD was then created. RESULTS: In total, 189 female patients with a minimum of one symptom were enrolled. Pelvic floor ultrasound revealed the presence of UD in 66 out of 189 (34.92%). Of the four symptoms, the combinations "LUTS + postmicturition dribble + UTI," "postmicturition dribble + LUTS," and "UTI + LUTS" were most significantly related to positive findings and had a higher positive prognostic value for the diagnosis of UD than each individual symptom alone (OR = 13.78 [95% CI: 6.95-16.35], p < 0.001; OR = 9.94 [95% CI: 4.60-12.2], p < 0.05; and OR = 5.78 [95% CI: 1.58-6.98] p = 0.05) respectively. CONCLUSION: Based on our model, the combination "LUTS + postmicturition dribble + UTI" seems to be the most sensitive combination of clinical symptoms predicting the positive finding of UD. This model could be used for patient counseling and for the identification of patients with UD.

Long-term outcomes after the excision of horseshoe urethral diverticulum.

INTRODUCTION AND HYPOTHESIS: The objective was to report our long-term experience with horseshoe urethral diverticulum (HUD) excised using the urethral preservation technique. METHODS: Following IRB approval, charts of women who underwent HUD excision and had at least 6 months' follow-up were reviewed. HUD was defined as a bilateral posterior diverticulum that extended laterally and anteriorly past 3 and 9 o'clock on the left and right sides respectively. HUD was diagnosed by pre-operative MRI. Success was defined as no evidence of residual diverticulum on post-operative imaging and the reported resolution of diverticulum symptoms. RESULTS: Between 1998 and 2014, 12 out of 15 women who underwent HUD excision met the inclusion criteria. Mean follow-up was 81 (median: 52, range: 7-163) months. Presenting symptoms included urinary leakage (n = 8), dyspareunia (n = 6), dysuria (n = 6), frequency (n = 5), urgency (n = 5), and vaginal pain (n = 8). Two patients reported having all three symptoms of the historic triad: dysuria, dyspareunia, and post-void dribbling. Three patients had prior urological interventions, including excision of a unilateral diverticulum, a Spence procedure, and a Skene gland incision. Only 1 patient had a recurrent HUD confirmed by MRI 10 years later, which required reoperation. HUD symptoms resolved in the remaining 11 patients, with post-operative imaging showing no evidence of recurrent HUD, and no further therapy was needed. Of 4 women who reported stress urinary incontinence (SUI) pre-operatively, only 2 reported SUI symptoms post-operatively. There were no cases of post-operative urethro-vaginal fistula. CONCLUSION: At a mean follow-up of 6-7 years, excision of HUD with urethral preservation produced long-lasting resolution in the majority of patients.

Simultaneous Treatment of Female Urethral Diverticulum and Stress Urinary Incontinence with Urethral Diverticulectomy and Suburethral Synthetic Mesh Sling.

OBJECTIVES: Pubovaginal fascial sling along with urethral diverticulectomy has been advised as the most appropriate anti-incontinence procedure for female stress urinary incontinence (SUI) with concomitant urethral diverticula (UD). We believe that suburethral synthetic mesh tape sling can also be safely used in some patients with concomitant SUI and UD. Herein, we present our experience for simultaneous treatment of UD and SUI with urethral diverticulectomy and suburethral synthetic mesh tape sling. METHODS: From 2003 to 2008, there are three patients with UD and SUI in our institution. They received transvaginal urethral diverticulectomy and suburethral synthetic mesh tape sling simultaneously. Videourodynamics was done before and three months after the surgery. RESULTS: Preoperative pelvis magnetic resonance imaging and videourodynamic study showed UD over distal urethra and SUI in all three patients. Urinalysis disclosed mild pyuria in two of the patients, and they both received intravenous antibiotics treatment to eradicate the infection prior to the surgery. They all underwent urethral diverticulectomy with suburethral synthetic mesh tape sling. The postoperative videourodynamic study showed no recurrence of UD and SUI. With a mean follow up of 33.3 months, there was no infection or exposure of synthetic mesh tape. CONCLUSIONS: In patients with UD and SUI, suburethral sling using synthetic mesh can be as effective and safe as facial sling in selected patients.

Female Acute Urinary Retention Caused by Urethral Diverticulum

We report two cases of acute urinary retention in women with urethral diverticulum. Cystoscopy were performed all patients. But diverticular opening was not found. All patients failed voiding by a bladder outlet obstruction. In one case, bladder outlet obstructive symptom resolved completely after the surgical removal of the diverticulum. In another case, patient refused operation.

The Effects of a Pubovaginal Sling Procedure, with Martius Labial Fat Pad Interposition, after a Female Urethral Diverticulectomy / 대한비뇨기과학회지

PURPOSE: We evaluated the effects of a pubovaginal sling (PVS), with a Martius labial fat pad interposition (MLFI), on patients with a female urethral diverticulum. MATERIALS AND METHODS: 23 consecutive cases with a female urethral diverticulum were retrospectively reviewed. The pre-operative evaluations included the history, physical examination, voiding cystourethrogram, cystoscopy, transperineal ultrasound and urodynamic studies to investigate the urethral function and the concomitant stress urinary incontinence. The treatment consisted of a transvaginal diverticulectomy alone, or with a PVS only, or combined with a MLFI. RESULTS: A transvaginal diverticulectomy only was performed, using a 3-layer closure, in nine patients (39.1%) and a concomitant PVS with a diverticulectomy in eight (34.8%) with stress urinary incontinence. A MLFI, combined with the above procedure, was performed in six patients (26.1%) with large defects of the urethra following the resection of diverticulum. No women having undergone a diverticulectomy with, or without, a PVS and MLFI had an urethrovaginal fistula, recurrent diverticulum or postoperative incontinence. CONCLUSIONS: In complicated cases, a simultaneous transvaginal diverticulectomy, pubovaginal sling and Martius labial fat pad interposition can be performed safely and effectively.

A Case of Female Urethral Bilobed Diverticulum, which is diagnosed by using positive pressure urethrogram

No abstract available.

Female Urethral Diverticulum: Review of 6 Cases / 대한비뇨기과학회지

Female urethral diverticulum is an uncommon entity but being diagnosed with increasing frequency according to improvement of diagnostic maneuver and increment of general awareness of the condition. Herein we reviewed 6 cases of female urethral diverticulum. Common presentations were dysuria, pus per urethra, frequency and postvoid dribbling. Variable sized masses were palpable on periurethral anterior vaginal wall Streptococcal infection. 2 diverticula were revealed in radiologic studies. Excision of diverticulum was performed in all patients. Intraoperatively urethral injury was made in 3 patients, among them 2 patients had no complication but one patient developed urethrovaginal fistula and urinary incontinence which did not disappear in 6 month follow-up. For the diagnosis of female urethral diverticulum, the most important thing is the high index of suspicion prior to many diagnostic tools.