Diagnosis of urethral diverticula and periurethral masses.

Aim: To give recommendations for the standard diagnostic assessment of uret hral diverticula and periurethral masses based on an evaluation of our resu lts and a survey of the recent literature. Methods: Group I (1981-1993) inc luded 47 women in whom urethral diverticula (n=34), periurethral cysts (n=1 1), and periurethral leiomyomas (n=2) were diagnosed and the results compar ed with the intraoperative findings. Diagnostic work-up comprised history t aking, vaginal palpation, introitus ultrasound, double-balloon urethrograph y (DBU), voiding cystourethroscopy (VCU), excretion urography (EU), and ure throcystoscopy. Group II (1994-1996) included 12 women with urethral divert icula who were examined by DBU, 2D and 3D introitus ultrasound. The diagnos tic accuracy of the different methods was assessed. Results: Group I: The d iagnostic accuracy in identifying urethral diverticula was 85.3% for palpat ion, 61.5% for introitus ultrasound, 93.8% for DBU, 37.5% for EU, and 30.0% for urethrocystoscopy. Of all imaging modalities used, only introitus ultr asound depicted periurethral cysts and leiomyomas. Group II: The DBU, 2D an d 3D introitus ultrasound had a diagnostic accuracy of 100% in identifying urethral diverticula. Conclusions: Introitus ultrasound should be used as t he basic diagnostic tool in clinically suspected urethral diverticula or pe riurethral masses and additional DBU should be restricted to cases with inc onclusive findings.