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

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.

Automated summary

The objective of the study was to establish a model to predict the presence of female urethral diverticulum (UD) based on symptoms. A prospective CHECK-UD study was conducted on female patients presenting with various symptoms. The combination of LUTS + postmicturition dribble + UTI was found to be the most sensitive in predicting the positive finding of UD.