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535 Double balloon urethrography for diagnosing urethral diverticula in women – is it still relevant in the 21st century?
535 - Double balloon urethrography for diagnosing urethral diverticula in women - is it sti... Page 1 of 2
e535 Double balloon urethrography for diagnosing urethral diverticula in women - is it still relevant in the 21st century? 1
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Erlich T. , Portnoy O. , Kitrey N.D. , Mor Y. , Ramon J. , Golomb J. 1
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Chaim Sheba Medical Center, Tel-Hashomer, Dept. of Urology, 2
Ramat Gan, Israel, Chaim Sheba Medical Center, Tel-Hashomer, Dept. of Imaging, Ramat Gan, Israel INTRODUCTION & OBJECTIVES: The diagnosis of a urethral diverticulum (UD) in women is based on detailed history, physical examination, and imaging. Imaging studies are required for proper delineation of the diverticulum, and supply the surgeon with anatomical data which are considered vital prior to embarking on surgery. The imaging studies in clinical practice today include Voiding Cystourethrography (VCUG), Double Balloon Urethrography (DBU) and Magnetic Resonance Imaging (MRI) of the urethra. The purpose of this study is to review our experience with DBU in the diagnosis of UD in women. MATERIAL & METHODS: Women with a clinical suspicion for a UD underwent an ambulatory DBU study, utilizing a Davis-model catheter (C.R. Bard, Inc.). The collected data included the presence of UD, as well as its location, number, configuration and complexity, relation to the bladder neck region and connection to the urethra. RESULTS: Between 2001 and 2011, 37 women, aged 38±13 years (range 20-82), with a suspected UD, underwent DBU at our institution. In 15 women (40.5%) the test was negative. In 22 patients, a total of 29 diverticula were demonstrated, of whom 16 (72.7%) had 1 diverticulum, 5 (22.7%) had 2 UD and 1 (4.6%) had 3 UD. A single round diverticulum was demonstrated in 9/22 studies (40.9%) while in 13/22 patients (59.1%) a complex UD was diagnosed. 11/29 of the diverticula (38%) were located in the proximal urethra, 9/29 (31%) in the mid-urethra and 9/29 (31%) in the distal urethra. The connection of the UD to the urethra was demonstrated in 12/22 patients (54.5%).
file://F:\RamShankar\April\04-05-12\Cip\Sour\535.html
4/7/2012
535 - Double balloon urethrography for diagnosing urethral diverticula in women - is it sti... Page 2 of 2
e535a CONCLUSIONS: DBU is a highly accurate imaging study in the diagnosis of UD in women. It provides vital and detailed anatomical data regarding the structure of the diverticulum, and thus it may improve the surgical success rate. In addition, DBU is a simple and inexpensive study, and in our hands it is well tolerated by most patients, with minimal discomfort. We therefore conclude that DBU should be still considered as a viable option in the diagnostic process of a UD in women.
file://F:\RamShankar\April\04-05-12\Cip\Sour\535.html
4/7/2012
e535 Double balloon urethrography for diagnosing urethral diverticula in women - is it still relevant in the 21st century? 1
2
1
1
1
Erlich T. , Portnoy O. , Kitrey N.D. , Mor Y. , Ramon J. , Golomb J. 1
1
Chaim Sheba Medical Center, Tel-Hashomer, Dept. of Urology, 2
Ramat Gan, Israel, Chaim Sheba Medical Center, Tel-Hashomer, Dept. of Imaging, Ramat Gan, Israel INTRODUCTION & OBJECTIVES: The diagnosis of a urethral diverticulum (UD) in women is based on detailed history, physical examination, and imaging. Imaging studies are required for proper delineation of the diverticulum, and supply the surgeon with anatomical data which are considered vital prior to embarking on surgery. The imaging studies in clinical practice today include Voiding Cystourethrography (VCUG), Double Balloon Urethrography (DBU) and Magnetic Resonance Imaging (MRI) of the urethra. The purpose of this study is to review our experience with DBU in the diagnosis of UD in women. MATERIAL & METHODS: Women with a clinical suspicion for a UD underwent an ambulatory DBU study, utilizing a Davis-model catheter (C.R. Bard, Inc.). The collected data included the presence of UD, as well as its location, number, configuration and complexity, relation to the bladder neck region and connection to the urethra. RESULTS: Between 2001 and 2011, 37 women, aged 38±13 years (range 20-82), with a suspected UD, underwent DBU at our institution. In 15 women (40.5%) the test was negative. In 22 patients, a total of 29 diverticula were demonstrated, of whom 16 (72.7%) had 1 diverticulum, 5 (22.7%) had 2 UD and 1 (4.6%) had 3 UD. A single round diverticulum was demonstrated in 9/22 studies (40.9%) while in 13/22 patients (59.1%) a complex UD was diagnosed. 11/29 of the diverticula (38%) were located in the proximal urethra, 9/29 (31%) in the mid-urethra and 9/29 (31%) in the distal urethra. The connection of the UD to the urethra was demonstrated in 12/22 patients (54.5%).
file://F:\RamShankar\April\04-05-12\Cip\Sour\535.html
4/7/2012
535 - Double balloon urethrography for diagnosing urethral diverticula in women - is it sti... Page 2 of 2
e535a CONCLUSIONS: DBU is a highly accurate imaging study in the diagnosis of UD in women. It provides vital and detailed anatomical data regarding the structure of the diverticulum, and thus it may improve the surgical success rate. In addition, DBU is a simple and inexpensive study, and in our hands it is well tolerated by most patients, with minimal discomfort. We therefore conclude that DBU should be still considered as a viable option in the diagnostic process of a UD in women.
file://F:\RamShankar\April\04-05-12\Cip\Sour\535.html
4/7/2012