The significance of urethral hyperechogenicity in female lower urinary tract symptoms

Objective: To explore the significance of hyperechogenic spots in the urethra on ultrasound cystourethrography. Methods: One hundred and five women with lower urinary tract symptoms who had undergone urodynamic study and ultrasound cystourethrography were included. Ultrasound cystourethrography was used to evaluate the morphology of the lower urinary tract, including the bladder neck position, bladder wall thickness at the trigone and dome, and presence or absence of hyperechogenic spots (urethral hyperechogenicity) in the urethra and their location and number. Results: Of the 105 women, 30 (29%) had hyperechogenic spots in the urethra, including 26 (87%) with only one spot; 17 (53%) of the echogenic spots were located in the proximal urethra, including four cases with multiple echogenic spots. No significant differences were found in the demographics, urinary symptoms, ultrasonographic, urodynamic and urethrocystoscopic findings between those women with and without urethral hyperechogenicity, except for parity (P = 0.030). There was no association between urethral hyperechogenicity and urinary symptoms. A weak but negative correlation between the number of echogenic spots in the urethra and maximum urethral pressure was found in the subgroup with urethral hyperechogenicity (r = -0.421; P = 0.023). Conclusion: On ultrasound cystourethrography, a single echogenic spot in the urethra is not associated with specific urinary symptoms and does not affect urethral function.