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OP20.03: Translabial ultrasound for the diagnosis of urethral diverticula
Author(s) -
Guichard P.,
Gillor M.,
CaudwellHall J.,
Dietz H.P.
Publication year - 2018
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.19577
Subject(s) - medicine , urethral diverticulum , ultrasound , cystoscope , abnormality , population , lower urinary tract symptoms , retrospective cohort study , diverticulum (mollusc) , urethra , surgery , radiology , prostate , environmental health , psychiatry , cancer
Objectives: Urethral diverticula (UD) are an uncommon cause of lower urinary tract symptoms in women. There is often significant delay to diagnosis. This study was designed to review ten years of experience with UD diagnosed by 4D translabial ultrasound. Methods: This was a retrospective review of patients seen between 2008 and 2018. 4121 women were examined by 3D/4D TLUS and urethroscopy with a 0-degree cystoscope. Archived US volumes were analysed in all women with the tentative or final diagnosis of ’urethral diverticulum’. Results: Of 4121 women seen during the inclusion period, 25 were found to have a major urethral abnormality on TLUS (0.6%). Of those, 17 had a cystic structure while 8 showed other abnormalities such as multiple hyperechogenic foci (HF). Urethroscopy confirmed a diverticulum in 16; 13 of which had had a cystic structure, and three multiple HF. In the 16 patients with confirmed UD, mean age was 48 (33-70) years, mean parity 2 (0-4). 7/16 (43%) presented with recurrent UTIs; the same number showed an anterior vaginal wall mass on exam. All except one were posterior. Mean maximum diameter was 13.4 (5-24) mm. The UD was simple in 8/13 (62%) and complex (ie. multilocular and/or covering >80% of the urethral circumference) in 5/13. A tract was identified on TLUS in 11/13 (84%). Conclusions: Translabial ultrasound is a valid noninvasive firstline method for the diagnosis of UD. Incidence is well below 1% in our population. A cystic structure traversing the rhabdosphincter has a high predictive value for the urethroscopic diagnosis of UD. Multiple hyperechogenic foci may indicate the presence of a small diverticulum.