Radiologic diagnosis and surgical treatment of urethral diverticulum in women - A reaparaisal of voiding cystourethrography and positive pressure urethrography

OBJECTIVE: To reappraise the optimum radiologic procedure for the diagnosis of urethral diverticula in women and to assess the results of surgery. STUDY DESIGN: From January 1994 to December 1997, 132 urine-continent women with pelvic prolapse and the most characteristic symptoms of urethral dive rticulum underwent pelvic repair. In addition to routine urologic evaluatio ns and pelvic examinations, the women underwent voiding cys tourethrography (VCUG) and positive pressure urethrography (PPUG) with a double-balloon ca theter. The x-ray examination was scheduled as follows. One hundred thirty- two women initially underwent VCUG followed by a PPUG. Another VCUG was sub sequently performed on women with a negative PPUG finding. Twelve patients were excluded because they were unable to urinate for the first VCUG; thus, the study group was composed of the remaining 120 patients. Subsequently t hose patients underwent various pelvic operations, including total abdomina l/vaginal hysterectomy, abdominal colposacropexy, Manchester's operation, s acrospinous ligament suspension, diverticulectomy and colporrhaphy. RESULTS: Both VCLIG and PPUG were able to demonstrate the diverticula in 20 of the 120 women. Another 13 women showed positive findings on PPUG. Ten o f the 87 cases with a negative PPUG had a positive finding in the subsequen t VCLIG. Forty- two diverticula were detected in 39 patients during pelvic repair. The only complication of urethral diverticulectomy was urethrovagin al fistula, which occurred in 3 of the 39 patients. CONCLUSION: Though VCUG is not as sensitive as PPUG, it still has merits an d can be used as a screening test. If VCUG is inconclusive but clinical sus picion persists, particularly when PPUG is doubtful, magnetic resonance ima ging should be considered.