Diagnosis of female urethral diverticulum using transvaginal contrast-enhanced sonourethrography.

Introduction And Hypothesis: This study investigated the value of transvaginal contrast-enhanced sonourethrography for the diagnosis of female urethral diverticulum (UD) by comparing results of contrast-enhanced ultrasound images and surgical findings.

Methods: A total of 14 female UD patients underwent preoperative transvaginal contrast-enhanced sonourethrography between July 2010 and June 2012. History and physical examination were initially assessed by the same urologist. Transvaginal contrast-enhanced ultrasound imaging was performed and interpreted by the same ultrasonographer. Definite diagnosis was made by tracking the flow of the microbubbles into the cyst. Additionally, sagittal, cross-sectional, and dynamic images were obtained, and color Doppler ultrasound was applied in all cases. Data on the size, location, configuration, and opening of the UD was documented, and then compared with the surgical findings.

Results: The most common symptoms presenting in the UD patients included urinary incontinence (71.5 %), recurrent urinary tract infection (57.1 %), frequency (50 %), urgency (35.7 %), dysuria (35.7 %), and dyspareunia (21.4 %). On physical examination, 8 out of 14 patients (57.1 %) had a palpable anterior vaginal wall mass, while 6 out of 14 patients (42.9 %) had no palpable mass. Transvaginal contrast-enhanced sonourethrography revealed 17 diverticula orifices in total and correlated well with surgical findings regarding the size, location, configuration, and the opening of the UD.

Conclusions: In patients with chronic irritative bladder symptoms, but with no response to conventional treatment a high index of suspicion for UD should be maintained. Our study demonstrates that transvaginal contrast-enhanced sonourethrography is a useful tool for defining the size, location, configuration, and opening of the UD before surgery.