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Periurethral and Anterior Vaginal Wall Masses. Obstet Gynecol 2022; 140:778-783. [DOI: 10.1097/aog.0000000000004956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/03/2022] [Indexed: 11/05/2022]
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Giannitsas K, Athanasopoulos A. Female urethral diverticula: from pathogenesis to management. An update. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/eog.09.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Ying T, Li Q, Shao C, Zhu Z, Feng L, Hu B. Value of transrectal ultrasonography in female traumatic urethral injuries. Urology 2010; 76:319-22. [PMID: 20156650 DOI: 10.1016/j.urology.2009.11.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2009] [Revised: 11/20/2009] [Accepted: 11/24/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To estimate the value of transrectal ultrasonography (TRUS) in traumatic urethral injuries of various types in females. METHODS A total of 30 female patients with symptoms of urethral injuries after trauma underwent TRUS between January 2005 and July 2008. Of them, 28 patients with operative indications undertook operation; the other 2 received conservative management and then a follow-up ultrasonography. All outcomes were used to validate the results of TRUS. RESULTS Urethral injuries were clearly observed in 30 cases with TRUS. The continuity of urethral wall, unblocking of urethral lumen, and homogeneous echo of surrounding structures had been changed. Urethral injuries varied in types, including urethrovaginal fistula, urethral stricture, urethral rupture, and urethral hematoma. It was common to find several injury patterns simultaneously in 1 patient. The outcomes in 28 cases with operative indications were consistent with results of surgery. The other 2 cases were diagnosed as urethral hematoma by TRUS which disappeared in a follow-up sonography after 3 months' conservative management. CONCLUSIONS TRUS is a reliable technique to exhibit abnormalities in injured urethra associated with trauma in female.
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Affiliation(s)
- Tao Ying
- Department of Ultrasound in Medicine, Shanghai Jiao Tong University affiliated Sixth People's Hospital, Shanghai, People's Republic of China
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Migliari R, Pistolesi D, D'Urso L, Muto G. Recurrent pseudodiverticula of female urethra: five-year experience. Urology 2009; 73:1218-22. [PMID: 19375782 DOI: 10.1016/j.urology.2008.07.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2008] [Revised: 07/08/2008] [Accepted: 07/15/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To report our experience of transvaginal diverticulectomy with pubovaginal sling placement in a series of 32 women with recurrent urethral pseudodiverticula. METHODS A total of 32 women underwent surgical repair from January 2000 to June 2007. Of the 32 women, 12 had undergone other concomitant previous urethral surgery, predominantly for stress urinary incontinence. Transvaginal excision of the diverticulum and concomitant pubovaginal sling placement were performed routinely. The women were evaluated postoperatively for symptom relief, anatomic result, and postoperative continence status at 1, 6, and 12 months and annually thereafter. Pelvic magnetic resonance imaging was repeated after 1 year. RESULTS The mean follow-up was 4.3 years. In all cases, the voiding urethrogram after catheter removal showed a good urethral shape with an absence of urinary leaks. At the postoperative urodynamic investigation, 27 patients had an unobstructed and 5 an equivocal Blaivas-Groutz nomogram. Three patients (20%) reported a persistent degree of stress urinary incontinence, including 2 with grade 1 stress urinary incontinence and 1 with mixed incontinence. Two patients presented with clinically evident diverticulum recurrence, and in 1 patient, an intraurethral diverticulum, was found at the 1-year magnetic resonance imaging examination. CONCLUSIONS A pubovaginal sling added routinely to all diverticulectomy procedures offers significant support to the urethral repair and/or prevention of urinary incontinence, including in recurrent cases, and does not increase the risk of erosion into the urethra or fistula formation.
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Chou CP, Levenson RB, Elsayes KM, Lin YH, Fu TY, Chiu YS, Huang JS, Pan HB. Imaging of Female Urethral Diverticulum: An Update. Radiographics 2008; 28:1917-30. [DOI: 10.1148/rg.287075076] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Stav K, Dwyer PL, Rosamilia A, Chao F. Urinary Symptoms Before and After Female Urethral Diverticulectomy—Can We Predict De Novo Stress Urinary Incontinence? J Urol 2008; 180:2088-90. [DOI: 10.1016/j.juro.2008.07.049] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Kobi Stav
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Australia
- Department of Urology, Assaf Harofeh Medical Center, Zeriffin, and Sackler School of Medicine, Tel Aviv University, Israel
| | - Peter L. Dwyer
- Department of Urogynaecology, Mercy Hospital for Women, Melbourne, Australia
| | | | - Fay Chao
- Monash Medical Centre, Melbourne, Australia
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Prasad SR, Menias CO, Narra VR, Middleton WD, Mukundan G, Samadi N, Heiken JP, Siegel CL. Cross-sectional imaging of the female urethra: technique and results. Radiographics 2006; 25:749-61. [PMID: 15888623 DOI: 10.1148/rg.253045067] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Clinical assessment of women with urethral symptoms is difficult, necessitating further evaluation with imaging. Urethrography provides limited information on luminal abnormalities of the urethra. Recent advances in ultrasound (US) and magnetic resonance (MR) imaging have dramatically improved evaluation of the female urethra, clarifying findings at physical examination and providing accurate road maps for surgeons. High-resolution transvaginal US, transperineal US, and transurethral US are reliable techniques for diagnosis and characterization of urethral abnormalities. High-resolution multiplanar MR imaging with phased-array pelvic and endovaginal coils demonstrates the urethral anatomy in greater detail. In women with urethral diverticula, US and MR imaging demonstrate the number of diverticula and the location, size, configuration, and possible contents of the sac. Most important, the position of the neck of the diverticulum may be identified for the surgeon. Imaging features do not allow differentiation between histologic subtypes of urethral carcinoma; the diagnosis is established with histopathologic examination. Periurethral cysts do not communicate with the urethra and therefore can often be differentiated from urethral diverticula at endocavitary MR imaging. High-resolution multiplanar US and MR imaging allow comprehensive evaluation of abnormalities of the female urethra.
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Affiliation(s)
- Srinivasa R Prasad
- Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78229, USA.
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Abstract
OBJECTIVE To review the urethral diverticula encountered in a tertiary-referral urogynaecology unit. PATIENTS AND METHODS The case-notes of all women who had a diverticulectomy between March 1996 and May 2001 were reviewed. Demographic details, symptoms at presentation, duration of symptoms before diagnosis, investigations, operative details, postoperative complications and symptoms at follow-up were considered. RESULTS In all, 18 women had had a urethral diverticulectomy. The median (range) time from presentation to diagnosis was 9.5 (2-96) months. The symptoms before surgery were variable; after surgery there were significant improvements in the symptoms of frequency, terminal dribbling and recurrent urinary tract infections (P < 0.05). There was no improvement in urgency, urge incontinence, nocturia and stress incontinence. Eleven of the 18 diverticula were palpable on vaginal examination. Video cysto-urethrography was used in 15 women and the diverticulum was seen in 14. In addition, seven women had additional lower urinary tract pathology. CONCLUSIONS Urethral diverticula have no classical presentation; they often present with many symptoms and it is important that the diagnosis is not overlooked. Video cysto-urethrography is a good diagnostic test and allows the simultaneous evaluation of function of the whole of the lower urinary tract.
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Affiliation(s)
- Jane Rufford
- Department of Urogynaecology, King's College Hospital, London, UK
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Blaivas JG, Flisser AJ, Bleustein CB, Panagopoulos G. Periurethral Masses: Etiology and Diagnosis in a Large Series of Women. Obstet Gynecol 2004; 103:842-7. [PMID: 15121554 DOI: 10.1097/01.aog.0000124848.63750.e6] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the differential diagnosis of periurethral masses in a consecutive series extracted from a single tertiary urogynecologic practice database. METHODS A patient database of a private urology and urogynecology practice with 1,950 women was searched for patients who were found to have a periurethral mass during the accrual dates of 1994 to 2002, and these records were reviewed for diagnostic testing and results. All women provided a history, completed a questionnaire, and underwent physical examination, voiding diary, cystoscopy, and videourodynamic testing; selected patients then underwent additional imaging. RESULTS Seventy-nine (4%) patients aged 41.2 +/- 14 years were identified. Of these, 72 (91%) had been referred for evaluation of persistent irritative lower urinary tract symptoms or incontinence. Seven patients (9%) had been referred specifically because of a periurethral mass. Sixty-six patients (84%; 95% confidence interval [CI] 73%, 91%) had urethral diverticula, of which 4 (6%; 95% CI 2%, 14.8%) contained malignancies. Six patients (7%; 95% CI 3%, 15%) had vaginal cysts histologically identified as fibromuscular tissue, 4 (5%; 95% CI 1%, 12%) had leiomyomata, and 2 (2.5%; 95% CI 0.03%, 8.8%) had ectopic ureteroceles. Two patients had vaginal squamous cell carcinomas (2.5%; 95% CI 0.03%, 8.8%), and 1 had an infected granuloma. Masses were palpable in 42 patients (53.8%; 95% CI 42%, 64%) and in 37 patients either were encountered at surgery (n = 5) or were urethral diverticula diagnosed by voiding cystourethrogram (n = 32). CONCLUSION Periurethral masses were encountered in less than 4% of our patient sample. Most masses were urethral diverticula; however, the differential diagnosis included leiomyoma, vaginal cysts, and malignancy. Masses were generally either palpable or seen at imaging studies performed during evaluation of lower urinary tract symptoms.
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Affiliation(s)
- Jerry G Blaivas
- Joan and Sanford Weill College of Medicine, Cornell University, New York, New York 10021, USA.
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Rovner ES, Wein AJ. Diagnosis and reconstruction of the dorsal or circumferential urethral diverticulum. J Urol 2003; 170:82-6; discussion 86. [PMID: 12796650 DOI: 10.1097/01.ju.0000067291.70172.b5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Uncommonly a saddlebag urethral diverticulum (UD) may extend circumferentially around the urethra dorsally or anteriorly with compromise of the adjacent tissues. Excision of the entire mucosalized surface of this type of UD may leave an extensive gap in the urethra. Unfortunately the full extent of a saddlebag UD is often not appreciated on preoperative imaging and it is only discovered intraoperatively when potential reconstructive flaps have already been compromised. The advent of endoluminal magnetic resonance imaging (eMRI) has provided outstanding preoperative staging that has greatly aided in the successful reconstruction of the cases. We present our experience with the diagnosis and reconstruction of these complex UDs. MATERIALS AND METHODS A review of 41 patients with UD at a single institution revealed 9 with circumferential involvement of the urethra confirmed on eMRI. All patients had voiding cystourethrography as the initial diagnostic modality. Four of the 9 patients had had at least 1 prior attempt at surgical repair elsewhere. Presenting symptoms included severe pain in 7 of the 9 patients, recurrent cystitis in 7, a vaginal mass in 2 and mixed urinary incontinence in 6. Eight of the 9 patients had undergone attempted surgical repair. Surgical reconstruction consisted of complete division of the urethra to access the dorsal wall of the UD with partial urethrectomy. Urethral continuity was restored by end-to-end urethroplasty in 5 patients and by tubularizing the dorsal (anterior) wall of the UD to construct a neourethral segment in 3. A Martius flap and pubovaginal sling were used selectively. Postoperatively voiding cystourethrography was performed in all patients to document absence of the UD. Self-administered patient questionnaires were completed preoperatively and postoperatively. RESULTS All patients report subjective relief of pain. Six of 8 patients did not use pads for incontinence. One patient used 2 to 3 pads daily for stress urinary incontinence symptoms and 1 had persistent urgency with rare incontinence, for which she used 1 pad daily. Complications included a distal urethrovaginal fistula in 1 patient and urethral stricture in 1. CONCLUSIONS Circumferential UD is an unusual problem. However, with the use of eMRI as a diagnostic and staging modality the incidence may be higher than previously realized. Preoperative knowledge of the extent of the UD is helpful in ensuring complete excision of the UD and optimizing urethral reconstruction. We conclude that excision and reconstruction of the circumferential UD is possible with excellent symptomatic and anatomical results.
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Affiliation(s)
- Eric S Rovner
- Division of Urology, Department of Surgery, School of Medicine, Hospital of the University of Pennsylvania, 1 Rhoads, 3400 Spruce Street, Philadelphia, PA 19104, USA
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Cross JJ, Fynes M, Berman L, Perera D. Prevalence of cystic paraurethral structures in asymptomatic women at endovaginal and perineal sonography. Clin Radiol 2001; 56:575-8. [PMID: 11446756 DOI: 10.1053/crad.2000.0709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To prospectively assess the prevalence of paraurethral cystic structures in asymptomatic adult women. PATIENTS AND METHODS One hundred and forty consecutive women undergoing endovaginal sonography with no history of lower urinary tract symptoms. RESULTS Paraurethral cystic structures were identified in 4/140 subjects (2.9%). Ultrasound assessment allowed rapid definition of the site, size and vascularity of these lesions and was well tolerated by the patient. CONCLUSION This is the first prospective ultrasound study to determine the prevalence of paraurethral cystic structures in a large consecutive cohort of asymptomatic women. Our findings are in accordance with previously published post-mortem data and surgical series which have estimated the prevalence of paraurethral cystic structures to be between 1 and 6%.
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Affiliation(s)
- J J Cross
- University Department of Radiology, Cambridge University and Addenbrooke's Hospital, Cambridge, UK
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Blander DS, Rovner ES, Schnall MD, Ramchandani P, Banner MP, Broderick GA, Wein AJ. Endoluminal magnetic resonance imaging in the evaluation of urethral diverticula in women. Urology 2001; 57:660-5. [PMID: 11306374 DOI: 10.1016/s0090-4295(00)01082-7] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Accurate determination of the size and extent of urethral diverticula can be important in planning operative reconstruction and repair. Voiding cystourethrography (VCUG) is currently the most commonly used study in the preoperative evaluation of urethral diverticula. We reviewed our experience with the use of endoluminal (endorectal or endovaginal) magnetic resonance imaging (eMRI) in these patients as an adjunctive study to VCUG to evaluate whether the MRI provided anatomically important information that was not apparent on VCUG. METHODS A retrospective analysis of all patients with a clinical diagnosis of urethral diverticula undergoing MRI at a single institution was performed. Patients were evaluated with history, physical examination, cystoscopy, VCUG, and eMRI. Endoluminal MRI was retrospectively compared to VCUG with respect to size, extent, and location found at operative exploration. RESULTS Twenty-seven consecutive patients underwent endorectal or endovaginal coil MRI in the evaluation of suspected urethral diverticula. Twenty patients subsequently had attempted transvaginal operative repair of the diverticulum. In 2 patients, eMRI demonstrated a urethral diverticulum, whereas VCUG did not. Operative exploration in these patients revealed a urethral diverticulum. In 14 of 27 patients, the VCUG underestimated the size and complexity of the urethral diverticulum as compared to eMRI and operative exploration. In 13 of 27 patients, the size, location, and extent of the urethral diverticulum on VCUG correlated well with the eMRI and/or operative findings. CONCLUSIONS We have found endorectal and endovaginal coil MRI to be extremely accurate in determining the size and extent of urethral diverticula as compared to VCUG. This information can be critical when planning the approach, dissection, and reconstruction of these sometimes complex cases.
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Affiliation(s)
- D S Blander
- Division of Urology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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ROMANZI LAURIJ, GROUTZ ASNAT, BLAIVAS JERRYG. URETHRAL DIVERTICULUM IN WOMEN: DIVERSE PRESENTATIONS RESULTING IN DIAGNOSTIC DELAY AND MISMANAGEMENT. J Urol 2000. [DOI: 10.1016/s0022-5347(05)67377-6] [Citation(s) in RCA: 146] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- LAURI J. ROMANZI
- From the Departments of Obstetrics and Gynecology, and Urology, Weill Medical College, Cornell University, New York, New York
| | - ASNAT GROUTZ
- From the Departments of Obstetrics and Gynecology, and Urology, Weill Medical College, Cornell University, New York, New York
| | - JERRY G. BLAIVAS
- From the Departments of Obstetrics and Gynecology, and Urology, Weill Medical College, Cornell University, New York, New York
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