Preoperative CT Voiding Cystourethrography Using 16-Multidetector CT in Female Urethral Diverticulum

Abstract

PurposeTo evaluate the clinical usefulness of preoperative CT voiding cystourethrography (CT-VCUG) using 16-multidetector computed tomography for female urethral diverticula.Materials and MethodsPreoperative 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.ResultsA 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.ConclusionsPreoperative 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.

Preoperative 3D and 4D-CT imaging using 640-Multislice CT (640-MSCT) in diagnosis of female urethral diverticulum

“…In the study of Lee et al [ 4 ], the sensitivity of cystourethroscopy was 71.4%, and in the study of Pathi et al [ 11 ], the sensitivities, specificities, positive predictive values (PPVs) and negative predictive values (NPVs) of cystourethroscopy were 33, 100, 100 and 42%, respectively. Similar to the study of Pathi, the sensitivity of cystourethroscopy in our group was only 40% (4 for 10).…”

“…Traditionally, some UDs can be diagnosed correctly by physical examination and clinical symptoms. However, it is a pity that diagnosis of most cases depends on ultrasonography (US), multidetector computed tomography (CT) and magnetic resonance imaging (MRI), or invasive techniques such as cystourethroscopy, voiding cystourethrogram (VCUG) and urethrography [ 4 , 5 ], even on operation.…”

“…Today, with the advance of imaging, the diagnosis of UD depends on the imaging more and more. US, CT, MRI, VCUG and CT-VCUG [ 4 , 5 ] have been used as modalities for diagnosis of UD. None of them has ideal sensitivity and specificity, and no one can be considered as the golden diagnostic standard.…”

Female urethral diverticula: An elusive pathology that can cause significant problems

“…33 Identifying the ostium is important for planning the surgery, and is identified preoperatively through imaging techniques. 41 A series of small-scale studies publishing the outcomes for patients post-diverticulectomy overall show positive results, with the majority of studies reporting cure rates between 70% and 80%. 10 Postoperative complications can include: recurrence, SUI, urethral narrowing and urethral vaginal fistulae.…”

“…3,39,40 CT-VCUG allows more detailed visualisation of the diverticulum and the ostium. 41 VCUG is disadvantageous in that it exposes the patient to ionising radiation and involves catheterisation of the patient. 39,40 CT can also be used on its own to image urethral diverticula and can be useful in identifying stones and neoplasms.…”