Transvaginal sonographic findings in diagnosis and treatment of urethral stricture

Female urethral stricture disease

Female urethral stricture disease is a rare entity. The most common etiologies are traumatic injury, iatrogenic injury, and inflammatory disease resulting in periurethral fibrosis. Hallmark symptoms are frequency and urgency, and may also be dysuria, hesitancy, slow stream, incontinence, and recurrent urinary tract infections. Female bladder outlet obstruction is a difficult entity to define, and the subset representing stricture disease may also be elusive. The diagnosis of female urethral stricture disease is usually based on symptoms, meatal appearance, and difficult instrumentation of the patient. Other testing, such as urodynamics, voiding urography, or cystoscopy, may be helpful. Treatment options are conservative management with dilatation, endoscopic treatment, or open repair with various tissue flaps or grafts. Considerable controversy surrounds the efficacy of urethral dilatation in women with voiding dysfunction.

Two- and three-dimensional ultrasonographic findings in urethral stenosis with bladder wall trabeculation: case report

Female bladder outlet obstruction is uncommon. We report a case of bladder outlet obstruction secondary to urethral stenosis leading to bladder wall trabeculation. The patient presented at our clinic because of lower urinary tract symptoms including nocturia, urgency, bed wetting, hesitancy, straining to void, and incomplete emptying. Urodynamic study revealed a low maximum free uroflow rate, high residual urine volume, and low compliance on filling phase cystometry. Introital ultrasonography with two- and three-dimensional (2D and 3D) scanning displayed a constriction in the echolucent part of the lower-mid urethra with hyperechogenicity and a lattice-like appearance of the bladder wall. Cystourethroscopy confirmed urethral stenosis and bladder wall trabeculation. The voiding symptoms subsided after the urethral stenosis was relieved by urethral dilatation, but, despite some improvement, the irritative symptoms persisted. Introital ultrasonography with 2D and 3D scanning may help to clarify the cause of female bladder outlet obstruction.

Two- and three-dimensional sonographic findings in a case of distal urethral obstruction due to a paraurethral tumor

The cause of bladder outlet obstruction in women may be categorized generally into two types, functional and anatomical. On ultrasonography, the urethra appears as a tubular structure with a central echolucent part and surrounding hyperechogenic structures. Morphological changes in the echolucent portion of the urethra have been reported to be associated with voiding dysfunction. We present a case of distal urethral obstruction secondary to metastatic paraurethral adenocarcinoma. Three-dimensional sonography clearly demonstrated the configuration of the metastatic tumor and its spatial orientation in association with distal urethral obstruction.

The significance of urethral hyperechogenicity in female lower urinary tract symptoms

OBJECTIVE

To explore the significance of hyperechogenic spots in the urethra on ultrasound cystourethrography.

METHODS

One hundred and five women with lower urinary tract symptoms who had undergone urodynamic study and ultrasound cystourethrography were included. Ultrasound cystourethrography was used to evaluate the morphology of the lower urinary tract, including the bladder neck position, bladder wall thickness at the trigone and dome, and presence or absence of hyperechogenic spots (urethral hyperechogenicity) in the urethra and their location and number.

RESULTS

Of the 105 women, 30 (29%) had hyperechogenic spots in the urethra, including 26 (87%) with only one spot; 17 (53%) of the echogenic spots were located in the proximal urethra, including four cases with multiple echogenic spots. No significant differences were found in the demographics, urinary symptoms, ultrasonographic, urodynamic and urethrocystoscopic findings between those women with and without urethral hyperechogenicity, except for parity (P = 0.030). There was no association between urethral hyperechogenicity and urinary symptoms. A weak but negative correlation between the number of echogenic spots in the urethra and maximum urethral pressure was found in the subgroup with urethral hyperechogenicity (r = -0.421; P = 0.023).

CONCLUSION

On ultrasound cystourethrography, a single echogenic spot in the urethra is not associated with specific urinary symptoms and does not affect urethral function.