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Radiographic Misdiagnoses After Periurethral Bulking Agents

Gaines, Natalie, MD*; Gupta, Priyanka, MD; Khourdaji, Ayad S., MD*; Ehlert, Michael, MD; Parikh, Keval, MD§; Kohli, Harjivan, BS§; Sirls, Larry T., MD§

Female Pelvic Medicine & Reconstructive Surgery: July/August 2018 - Volume 24 - Issue 4 - p 312–314
doi: 10.1097/SPV.0000000000000440
Original Articles

Objectives Injectable urethral bulking agents are commonly used to manage stress urinary incontinence. Urologic or other symptoms may prompt pelvic imaging at a later date, when bulking agents may be visualized and incorrectly interpreted. Our goal was to evaluate the incidence of misdiagnosis and which pathologies were the most common misinterpretations and their frequency.

Methods All records were reviewed for patients who underwent periurethral injection for stress urinary incontinence for pelvic imaging after treatment from 2005 to 2015. Radiological reports were reviewed for any description potentially related to injection therapy, and descriptive statistics performed.

Results A total of 528 patients underwent injection of a urethral bulking agent. Of these, 79 patients (15%) had a total of 111 additional abdominal or pelvic imaging studies performed with abnormal periurethral findings mentioned. Thirty-nine (35%) of 111 studies were correctly interpreted as urethral bulking agents, and in 72 (65%) of 111 studies, the urethral bulking agents were not correctly identified. The most common misdiagnoses were bladder calcification (26; 23%), urethral diverticulum with stone (12; 11%), periurethral calcification (9; 8%), unknown pelvic density (8; 7%), and mass suspicious for malignancy (6; 5%).

Conclusions Urethral bulking agents commonly were not mentioned on subsequent imaging but, when commented on, were misinterpreted 65% of the time including worrisome pathologies (diverticulum with stone, unknown mass, and malignancy), requiring subsequent evaluation and potentially procedural/surgical management. It is critical for the ordering clinician to inform the radiologist of this history and for radiologists to consider bulking agents in the differential diagnosis of radiographic findings in this location.

From the *Department of Urology, Beaumont Health System, Royal Oak;

Department of Urology, University of Michigan, Ann Arbor, MI;

Metro Urology, Woodbury, MN; and

§William Beaumont School of Medicine, Oakland University, Rochester, MI.

Correspondence: Natalie Gaines, MD, Department of Urology, Beaumont Health System, 3535 W, 13 Mile Rd, Ste 438, Royal Oak, Michigan 48073. E-mail:

The authors have declared they have no conflicts of interest.

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