Combined three-dimensional multiplanar and tomographic ultrasound imaging for the diagnosis and preoperative planning of female urethral diverticulum: A prospective study

Purpose: To explore the diagnostic value of three-dimensional multiplanar imaging and tomographic ultrasound imaging (TUI) in detecting female urethral diverticula. Methods: This study was conducted at a tertiary teaching hospital, enrolling women who underwent two-dimensional (2D) and three-dimensional (3D) pelvic floor ultrasound (PFUS) from January 2021 to January 2025. The imaging data from 3D multiplane and tomographic ultrasound were reconstructed using 4D View software. Subsequently, the ultrasonographic findings were analyzed and compared with the surgical results to evaluate their diagnostic accuracy. Results: A total of 2185 patients underwent pelvic floor ultrasound (PFUS); of these, 25 were identified with peri-urethral cystic lesions. Nineteen of these patients were suspected to have urethral diverticula, and seventeen were subsequently confirmed through transvaginal urethral diverticulectomy or soft cystoscopy. Conclusion: Combined 3D multiplanar and TUI is a highly accurate, non-invasive, and cost-effective modality for diagnosing female urethral diverticula. It provides detailed morphological and spatial information crucial for differential diagnosis and preoperative planning. Combined 3D multiplanar and TUI is a highly effective tool for the accurate diagnosis and precise localization of female urethral diverticula. The visualization of the "cleft sign" at the neck of the diverticulum is a key diagnostic feature that differentiates UD from other periurethral cysts. This non-invasive, real-time imaging approach provides crucial information for preoperative surgical planning, potentially reducing operative time and complications. It represents a reliable and cost-effective first-line imaging modality for evaluating suspected female urethral diverticula.