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Correlation between symptoms and imaging findings including pelvic floor ultrasound to improve the symptom-based diagnosis of female urethral diverticulum (CHECK-UD study)

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Abstract

Introduction and hypothesis

The objective was to establish a model to predict the presence of a female urethral diverticulum (UD) based on symptoms.

Methods

A prospective CHECK-UD study (check of female urethral diverticulum) was conducted. Female patients presenting with symptoms such as lower urinary tract symptoms (LUTS), postmicturition dribble or urinary incontinence (UI), dyspareunia or pain in the pelvic area, and recurrent urinary tract infection (UTI) treated between 2015 and 2020 were included. The association between each symptom variable and the positive finding of UD was evaluated by multivariate logistic regression adjusting for age, body mass index (BMI), vaginal deliveries, previous surgery for SUI, previous pelvic surgery, and microscopic hematuria. A predictive model for the presence of UD was then created.

Results

In total, 189 female patients with a minimum of one symptom were enrolled. Pelvic floor ultrasound revealed the presence of UD in 66 out of 189 (34.92%). Of the four symptoms, the combinations “LUTS + postmicturition dribble + UTI,” “postmicturition dribble + LUTS,” and “UTI + LUTS” were most significantly related to positive findings and had a higher positive prognostic value for the diagnosis of UD than each individual symptom alone (OR = 13.78 [95% CI: 6.95–16.35], p < 0.001; OR = 9.94 [95% CI: 4.60–12.2], p < 0.05; and OR = 5.78 [95% CI: 1.58–6.98] p = 0.05) respectively.

Conclusion

Based on our model, the combination “LUTS + postmicturition dribble + UTI” seems to be the most sensitive combination of clinical symptoms predicting the positive finding of UD. This model could be used for patient counseling and for the identification of patients with UD.

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Abbreviations

ICC:

Intraclass correlation coefficient

ICIQ-SF:

Incontinence questionnaire short form

ICS:

International Continence Society

IUGA:

International Urogynecological Association

LUTS:

Urinary tract symptoms

MRI:

Magnetic resonance imaging

OAB:

Overactive bladder

PFUS:

Pelvic floor ultrasound

UD:

Urethral diverticulum

UI:

Urinary incontinence

UTI:

Urinary tract infection

VI:

Vaginal inspection

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Authors and Affiliations

  1. Department of Urology and Pediatric Urology, Hospital Viersen, Hoserkirchweg 63, 41747, Viersen, Germany

    Bara Barakat & Knut Franke

  2. Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany

    Sameh Hijazi

  3. Department of Urology, University Medicine Greifswald, Greifswald, Germany

    Ingmar Wolff

  4. Department of Urology and Pediatric Urology, University Hospital Essen, Essen, Germany

    Boris Hadaschik & Christian Rehme

Authors
  1. Bara Barakat
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  2. Knut Franke
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  3. Sameh Hijazi
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  4. Ingmar Wolff
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  5. Boris Hadaschik
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  6. Christian Rehme
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Contributions

B.B: had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis, manuscript writing/editing, protocol/project development, data collection or management, drafting of the manuscript, administrative, technical, and material support; K.F.: data collection or management; S.H.: data collection or management; I.W.: drafting of the manuscript, critical revision of the manuscript, administrative, technical, and material support, supervision; B.H.: critical revision of the manuscript, administrative, technical, and material support, supervision; C.R.: administrative, technical, and material support, supervision.

Corresponding author

Correspondence to Bara Barakat.

Ethics declarations

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent statement

Patients were required to give informed consent to the study. Clinical data were obtained after each patient had agreed to treatment by written consent.

Conflicts of interest

I certify that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (e.g., employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: none. The authors declare that they have no relevant conflicts of interest.

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Barakat, B., Franke, K., Hijazi, S. et al. Correlation between symptoms and imaging findings including pelvic floor ultrasound to improve the symptom-based diagnosis of female urethral diverticulum (CHECK-UD study). Int Urogynecol J 33, 2267–2274 (2022). https://doi.org/10.1007/s00192-021-04770-6

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  • DOI: https://doi.org/10.1007/s00192-021-04770-6

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