Prevalence of radiographic misinterpretation of urethral bulking agents: a retrospective, single-center study

Urethral bulking agents (UBA) are a treatment option for patients with stress urinary incontinence and can contain radiopaque material such that misdiagnosis for pelvic pathology occurs. We aim to characterize radiologic interpretation of UBA in patients who had computed tomography of the abdomen and pelvis (CTAP) after UBA.

All patients who underwent UBA from January 2011 to March 2024 were identified in the electronic medical record (EMR). Charts were reviewed to identify patients who underwent subsequent CTAP. Radiologic interpretations were reviewed to assess for accuracy in identification of the UBA as well as patient communications regarding imaging results.

During the study period, 144 patients underwent injection of UBA. Of those, 31 patients had ≥ 1 CTAP for a total of 61 CTAPs. Average duration of UBA to CTAP was 25.7 months. The UBA was accurately identified in only 15 (24.6%) scans. In 31 (50.8%) scans, neither UBA nor any abnormality was noted, and one of the authors confirmed presence of UBA in 30 of the 31 scans. UBA was inaccurately characterized as bladder stones (n = 7), nonspecific calcifications (n = 6), radiodense material (n = 1), and a urethral stone (n = 1) in the remaining 15 (24.6%) scans. Two patients with UBA who were misdiagnosed as bladder stones messaged via the patient portal about the findings with one expressing anxiety regarding the finding.

Urethral bulking agents are often inaccurately interpreted on CTAP potentially leading to anxiety and unnecessary intervention. This highlights the importance of raising awareness of UBA among radiologists.