The use of tomographic ultrasound imaging on three-dimensional translabial ultrasound: a diagnostic sign for urethral diverticulum

  • Dan Liu
  • Zhenzhen Qing
  • Lieming WenEmail author
Original Article


Introduction and hypothesis

The objective was to apply tomographic ultrasound imaging (TUI) to diagnose urethral diverticulum (UD) and summarize the specific imaging findings.


This was a retrospective analysis of 42 women with a paraurethral cyst. All women underwent a clinical interview, three-dimensional pelvic floor ultrasound and a transvaginal cystectomy between May 2016 and March 2019. UD was defined on TUI if a tract connecting the paraurethral cyst to the urethral lumen was shown in the urethral rhabdosphincter circular muscle in the pelvic floor axial plane. All patients’ demographics, history, clinical evaluation and surgical outcomes were reviewed.


On surgical findings, 33 women had a UD and 9 had a Gartner duct cyst. Characteristics of paraurethral cysts described by TUI were consistent with surgical findings in 40 patients (95%). Good agreement was shown by κ test (κ = 0.88, p < 0.001). Of 33 UD patients, the mean age was 45 years and the mean duration of symptoms was 6.5 months. The most common presenting symptom was recurrent urinary tract infection (17, 52%), followed by stress urinary incontinence and a vaginal lump (15, 46%). The mean maximum diameter of 33 UDs was 26 mm (range 8–45 mm). On TUI, one tract, connecting the paraurethral cyst to the urethral lumen, was identified as a gap in the hyperechoic rhabdosphincter muscle circle in the pelvic floor axial plane in 23 UDs (70%); there were two or more tracts in 8 (24%).


The diagnostic sign to identify urethral diverticulum is a gap in the hyperechoic urethral rhabdosphincter circle formed between the cyst and urethral lumen in the axial plane.


Urethral diverticulum Translabial ultrasound Tomographic ultrasound imaging Recurrent urinary tract infections 



This study was supported by “The Project of New Clinic Techniques of Central South University.”

Authors’ contributions

Wen Lieming: project development, data management, and manuscript editing; Liu Dan: data collection, manuscript writing and editing; Qing Zhenzhen: data collection.

Compliance with ethical standards

Conflicts of interest


Ethical approval

This study was approved by the Human Research Ethics Committee of the Second Xiangya Hospital (No.2019-041).


  1. 1.
    Baradaran N, Chiles LR, Freilich DA, Rames RA, Cox L, Rovner ES. Female urethral diverticula in the contemporary era: is the classic triad of the “3Ds” still relevant? Urology. 2016;94:53–6.CrossRefGoogle Scholar
  2. 2.
    El-Nashar SA, Singh R, Bacon MM, Kim-Fine S, Occhino JA, Gebhart JB, et al. Female urethral diverticulum: presentation, diagnosis, and predictors of outcomes after surgery. Female Pelvic Med Reconstr Surg. 2016;22(6):447–52.CrossRefGoogle Scholar
  3. 3.
    Chang YL, Lin AT, Chen KK. Presentation of female urethral diverticulum is usually not typical. Urol Int. 2008;80(1):41–5.CrossRefGoogle Scholar
  4. 4.
    Lee SR, Lim YM, Jeon JH, Park MH. Diagnosis of urethral diverticulum mimicking pelvic organ prolapse with translabial ultrasonography. Am J Obstet Gynecol. 2017;217(4):482.CrossRefGoogle Scholar
  5. 5.
    Dietz HP. The anterior compartment. In: Dietz HP, editor. Atlas of pelvic floor ultrasound. London: Springer. 2008. pp. 41–62.CrossRefGoogle Scholar
  6. 6.
    Gillor M, Dietz HP. Translabial ultrasound imaging of urethral diverticula. Ultrasound Obstet Gynecol. 2019. Scholar
  7. 7.
    Gugliotta G, Calagna G, Adile G, Polito S, Speciale P, Perino A, et al. Use of trans-labial ultrasound in the diagnosis of female urethral diverticula: a diagnostic option to be strongly considered. J Obstet Gynaecol Res. 2015;41(7):1108–14.CrossRefGoogle Scholar
  8. 8.
    Zhao YX, Wang JP, Li JM, Chen T, Mao CW, Liu JH, et al. Preoperative 3D and 4D-CT imaging using 640-multislice CT (640-MSCT) in diagnosis of female urethral diverticulum. World J Urol. 2017;35(7):1133–9.CrossRefGoogle Scholar
  9. 9.
    Doumouchtsis SK, Nazarian DA, Gauthaman N, Durnea CM, Munneke G. Three-dimensional volume rendering of pelvic models and paraurethral masses based on MRI cross-sectional images. Int Urogynecol J. 2017;28(10):1579–87.CrossRefGoogle Scholar
  10. 10.
    Wang X, Dou C, Yan Y, Song L, Hu B, Ying T. Preoperative transurethral contrast-enhanced ultrasonography in the diagnosis of female urethral diverticula. J Ultrasound Med. 2018;37(12):2881–9.CrossRefGoogle Scholar
  11. 11.
    Wang X, Dou C, Yan Y, Bai Y, Hu B, Ying T. Ultrasonographic features of female urethral diverticula: a retrospective study of 25 patients. Female Pelvic Med Reconstr Surg. 2017;23(5):343–7.CrossRefGoogle Scholar
  12. 12.
    Ashton-Miller JA, Howard D, DeLancey JO. The functional anatomy of the female pelvic floor and stress continence control system. Scand J Urol Nephrol Suppl. 2001;207:1–7 discussion 106-25.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Ultrasound DiagnosisThe Second Xiangya Hospital of Central South UniversityChangshaChina

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