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Utility of clinical parameters, cystourethroscopy, and magnetic resonance imaging in the preoperative diagnosis of urethral diverticula

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Abstract

Introduction and hypothesis

Our purpose was to assess the accuracy of history and physical, cystourethroscopy, and magnetic resonance imaging (MRI) in preoperative diagnosis of urethral diverticula.

Methods

This was a retrospective review of all patients who underwent surgical excision of periurethral masses between 1998 and 2009. Presenting symptoms and examination and cystourethroscopic findings were noted. A single pathologist reviewed all cases and provided the reference standard for the diagnosis of a diverticulum. A single radiologist reviewed all preoperative MRI studies. Sensitivities, specificities, and positive and negative predictive values (PPV, NPV) were determined.

Results

Diverticula were diagnosed in 36/60 (60 %) patients. Transurethral fluid expression on palpation and recurrent urinary tract infection (UTI) had high PPV. Sensitivity, specificity, PPV, and NPV, respectively, for cystourethroscopy were 33 %, 100 %, 100 %, and 42 %; for MRI, these were 100 %, 83 %, 92 %, and 100 %.

Conclusion

These data reinforce the utility of transurethral fluid expression for preoperative evaluation of urethral diverticula. Additionally, MRI is an excellent adjunctive diagnostic tool and may assist in establishing the diagnosis when there is high clinical suspicion of a urethral diverticulum but nonconfirmatory findings on cystourethroscopy.

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Authors and Affiliations

  1. Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Sujatha D. Pathi, David D. Rahn, Rebecca J. Stone, Donald D. McIntire & Clifford Y. Wai

  2. Departments of Pathology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Joseph L. Sailors

  3. Departments of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Vincent A. Graziano & Robert D. Sims

  4. Division of Female Pelvic Medicine & Reconstructive Surgery, Department of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9032, USA

    Clifford Y. Wai

Authors
  1. Sujatha D. Pathi
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  2. David D. Rahn
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  3. Joseph L. Sailors
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  4. Vincent A. Graziano
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  5. Robert D. Sims
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  6. Rebecca J. Stone
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  7. Donald D. McIntire
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  8. Clifford Y. Wai
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Correspondence to Clifford Y. Wai.

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Pathi, S.D., Rahn, D.D., Sailors, J.L. et al. Utility of clinical parameters, cystourethroscopy, and magnetic resonance imaging in the preoperative diagnosis of urethral diverticula. Int Urogynecol J 24, 319–323 (2013). https://doi.org/10.1007/s00192-012-1841-9

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  • DOI: https://doi.org/10.1007/s00192-012-1841-9

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