INTRAOPERATIVE ENDO-LUMINAL ULTRASOUND EVALUATION OF URETHRAL DIVERTICULA

The imaging accuracy of a catheter-based endo-luminal ultrasound syste m was compared to traditional imaging techniques for surgical treatmen t of urethral diverticula in 7 women and 1 man. At surgical repair the urethra was catheterized directly with a 6.2F or 9F (12.5 or 20 MHz.) catheter-based ultrasound transducer, generating a 360-degree transax ial real-time image. The endo-luminal ultrasound images were compared with preoperative voiding cystourethrography (7 patients), transvagina l ultrasound examinations (3) and double balloon urethrograms (2). Sur gical diverticulectomy was then done with endo-luminal ultrasound moni toring. Intraoperatively, all diverticula were well visualized by endo -luminal ultrasound, which demonstrated improved identification of the size and orientation of urethral diverticula, sludge within the diver ticula, the extent of periurethral inflammation, diverticular wall thi ckness, and the distance between the diverticular wall and urethral lu men. In 3 patients the urethral connections of the diverticula were ex ceptionally well visualized. Comparison with traditional imaging revea led 2 false-negative and 1 false-positive voiding cystourethrograms, 1 false-negative transvaginal ultrasound study and 1 false-negative dou ble balloon urethrogram. Intraoperative monitoring of the urethra enab led precise anatomical dissection, eliminated all diverticular compone nts, and prevented inadvertent urethral and bladder neck injury. Ureth ral endo-luminal ultrasound is a valuable new adjunct in the evaluatio n of a variety of urethral abnormalities. This new ultrasound applicat ion permits visualization of the precise size, location, orientation a nd characteristics of urethral diverticula and surrounding tissues. Th rough enhanced imaging, surgical repair is facilitated. Further applic ation of this technique should increase the diagnostic accuracy of ure thral imaging beyond radiographic techniques currently available.