Preoperative Transurethral Contrast‐Enhanced Ultrasonography in the Diagnosis of Female Urethral Diverticula

Wang, Xia; Dou, Chaoran; Yao, Yan; Song, Lujie; Hu, Bing; Ying, Tao

doi:10.1002/jum.14648

Cited by 9 publications

(6 citation statements)

References 37 publications

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“…Cystoscopy with visualisation of UD ostium at the 4 o'clock position just proximal to the mid-urethral sphincter. techniques, such as transurethral contrast-enhanced US have been reported to have a 95% sensitivity and 100% specificity in the diagnosis of UD [25]. VCUG offers the ability to visualise the UD when the ostium is patent, with a sensitivity of 67-95% [1,26] (Figure 7), but is limited by the invasive, uncomfortable nature of this study.…”

Section: Imagingmentioning

confidence: 92%

Urethral diverticulum: A systematic review

Greiman

Rolef

2019

Arab Journal of Urology

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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.

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Section: Imagingmentioning

confidence: 92%

Urethral diverticulum: A systematic review

Greiman

Rolef

2019

Arab Journal of Urology

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“…And ultrasound presentations correlated well with surgical findings, including location, configuration, septum, calcification, etc. (17,18). Meanwhile, transperineal ultrasound was also applied during follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…In our experience, most of UDs locate at 5 and 7 o'clock of the mid-distal urethra, where distributes paraurethral glands. Numerous surgical modalities of diverticulectomy to utmost restore urethral function have been reported, including total excision of the diverticular wall, the Spence procedure, Martius flap interposition, and so on (6,(9)(10)(11)(16)(17)(18)(19)(20). In Reeves et al study, total dissection of the diverticulum was performed (9).…”

Section: Discussionmentioning

confidence: 99%

“…And no accompanying LUTS were recorded. According to the published literatures, the overall successful rate for transvaginal excision of UD is about 90% (18). Of note, absolute removal of diverticular walls was done in almost all of the previous studies (18).…”

Section: Discussionmentioning

confidence: 99%

“…According to the published literatures, the overall successful rate for transvaginal excision of UD is about 90% (18). Of note, absolute removal of diverticular walls was done in almost all of the previous studies (18). Therefore, the surgical method of partial excision of diverticular walls had a comparable cure rate with total excision of diverticular walls.…”

Section: Discussionmentioning

confidence: 99%

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Transvaginal management of symptomatic complex urethral diverticula by definite closure of diverticula and robust reconstruction of the urethra

Yang¹,

Zhang²,

Chen³

et al. 2020

Transl Androl Urol

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Background: Management of complex urethral diverticula (UDs) is challenging not only for the ostia detection and urethral reconstruction in surgery but also for the high risk of postoperative complications. We aimed to present the experience of surgical management for UDs by transvaginal partial diverticulectomy and urethral reconstruction. Methods:The database of medical record library was retrospectively searched for patients underwent partial diverticulectomy for symptomatic complex UDs. During the surgical procedure, the cystourethroscopy was firstly performed to locate the diverticular ostium. The surgeon exposed and opened the diverticulum along its maximum axis. The surgeon recorded the location of ostia where saline solution flowed out, when one assistant pressed suprapubic region to increase inner-pressure of bladder and urethra.We focused on definite closure of diverticular ostia and robust urethral reconstruction.Results: The present study included 39 patients with mean age of 45 years. There were 28 patients, 23 patients and 21 patients suffering from recurrent urinary infection, frequency and urgency. Ten patients had stress urinary incontinence. All of the 39 patients had complex UDs because of U-shaped diverticula (24/39) and circumferential diverticula (15/39). Multiloculated UDs were detected in 17 out of 39 patients.During the median follow-up time of 2.0 (1.0-12.0) years, there was no case of de novo urinary incontinence.However, 2 patients still had mild stress urinary incontinence without additional treatment. At postoperative 3 months, five patients had para-urethral cysts with the size ranging from 0.3 to 0.4 cm, which were absorbed in follow-up. Conclusions:The method of transvaginal partial diverticulectomy, definite closure of diverticular ostium, and layered reconstruction of the urethra is a feasible surgical alternative for UDs.

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Contrast-Enhanced Voiding Urosonography (ceVUS): Current Experience and Advanced Techniques

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Darge

Ntoulia

2020

Contrast-Enhanced Ultrasound in Pediatric Imaging

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Preoperative Transurethral Contrast‐Enhanced Ultrasonography in the Diagnosis of Female Urethral Diverticula

Abstract: Transurethral CEUS is an effective method for identifying the structure and ostium of female urethral diverticula. It may have a potential role in preoperative planning and surgical management.

Cited by 9 publications

References 37 publications

Urethral diverticulum: A systematic review

Urethral diverticulum: A systematic review

Transvaginal management of symptomatic complex urethral diverticula by definite closure of diverticula and robust reconstruction of the urethra

Contrast-Enhanced Voiding Urosonography (ceVUS): Current Experience and Advanced Techniques

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