Chancellor M B, Liu J B, Rivas D A, Karasick S, Bagley D H, Goldberg B B
Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Urol. 1995 Jan;153(1):72-5. doi: 10.1097/00005392-199501000-00026.
The imaging accuracy of a catheter-based endo-luminal ultrasound system was compared to traditional imaging techniques for surgical treatment of urethral diverticula in 7 women and 1 man. At surgical repair the urethra was catheterized directly with a 6.2F or 9F (12.5 or 20 MHz.) catheter-based ultrasound transducer, generating a 360-degree transaxial real-time image. The endo-luminal ultrasound images were compared with preoperative voiding cystourethrography (7 patients), transvaginal ultrasound examinations (3) and double balloon urethrograms (2). Surgical diverticulectomy was then done with endo-luminal ultrasound monitoring. Intraoperatively, all diverticula were well visualized by endo-luminal ultrasound, which demonstrated improved identification of the size and orientation of urethral diverticula, sludge within the diverticula, the extent of periurethral inflammation, diverticular wall thickness, and the distance between the diverticular wall and urethral lumen. In 3 patients the urethral connections of the diverticula were exceptionally well visualized. Comparison with traditional imaging revealed 2 false-negative and 1 false-positive voiding cystourethrograms, 1 false-negative transvaginal ultrasound study and 1 false-negative double balloon urethrogram. Intraoperative monitoring of the urethra enabled precise anatomical dissection, eliminated all diverticular components, and prevented inadvertent urethral and bladder neck injury. Urethral endo-luminal ultrasound is a valuable new adjunct in the evaluation of a variety of urethral abnormalities. This new ultrasound application permits visualization of the precise size, location, orientation and characteristics of urethral diverticula and surrounding tissues. Through enhanced imaging, surgical repair is facilitated. Further application of this technique should increase the diagnostic accuracy of urethral imaging beyond radiographic techniques currently available.
在7名女性和1名男性中，对基于导管的腔内超声系统的成像准确性与用于尿道憩室手术治疗的传统成像技术进行了比较。在手术修复时，使用6.2F或9F（12.5或20MHz）基于导管的超声换能器直接对尿道进行插管，生成360度的经轴实时图像。将腔内超声图像与术前排尿性膀胱尿道造影（7例患者）、经阴道超声检查（3例）和双气囊尿道造影（2例）进行比较。然后在腔内超声监测下进行手术憩室切除术。术中，所有憩室均通过腔内超声清晰显示，这表明对尿道憩室的大小和方向、憩室内的淤渣、尿道周围炎症的程度、憩室壁厚度以及憩室壁与尿道腔之间的距离的识别有所改善。在3例患者中，憩室的尿道连接显示得格外清晰。与传统成像相比，排尿性膀胱尿道造影有2例假阴性和1例假阳性，经阴道超声检查有1例假阴性，双气囊尿道造影有1例假阴性。对尿道的术中监测能够进行精确的解剖分离，清除所有憩室成分，并防止意外的尿道和膀胱颈损伤。尿道腔内超声是评估各种尿道异常的一种有价值的新辅助手段。这种新的超声应用能够显示尿道憩室及周围组织的精确大小、位置、方向和特征。通过增强成像，有助于手术修复。该技术的进一步应用应能提高尿道成像的诊断准确性，超越目前可用的放射学技术。
