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


CONCLUSIONS
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.
Departments of Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Sujatha D
SD
Pathi
David D
DD
Rahn
Joseph L
JL
Sailors
Vincent A
VA
Graziano
Robert D
RD
Sims
Rebecca J
RJ
Stone
Donald D
DD
McIntire
Clifford Y
CY
Wai
D000328:Adult; D003558:Cystoscopy; D004240:Diverticulum / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D005260:Female; D013509:Gynecologic Surgical Procedures; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D057234:Preoperative Period; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014521:Urethra / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D014522:Urethral Diseases / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D013520:Urologic Surgical Procedures