Female Urethral Diverticulum

Female urethral diverticulum is an uncommon surgical entity, present in 0.6–6% of the population. This occurs predominantly in third to fifth decade of life, although has been reported in young females and neonates. It may arise from defective closure of the urethral folds, or as a rudimentary form of urethral duplication or acquired causes including infection, periurethral glands obstruction, repeated catheterization and trauma from childbirth. The symptom often varies and nonspecific consisting of dysuria, dyspareunia, recurrent urinary tract infection. Diverticulum can be of various shapes including simple, U-shaped and circumferential. It can be single or multiple. It is commonly located at the midurethra and on the posterolateral wall rather than on the anterior wall. Urethral diverticulum can be detected with constellation of history, physical examination, cystourethroscopy and imaging findings. However, clinical and radiological feature with improved diagnostic techniques is often helpful in making the correct diagnosis. Clinical awareness of urethral diverticulum is important as it is associated with potential complication including recurrent infection, stones and carcinoma. Although transurethral and transvaginal sonography can be used to characterize urethral diverticulum, they are limited by field of view and patient body habitus. MRI provides excellent tissue contrast and multiplanar capablilties in delineating detail anatomy of female urethra. It can very well reveal the extent of the lesion, quite helpful in the surgical planning of the lesion. Urethral diverticulm is seen as bright (hyperintense) on T2-weighted sequences adjacent to or surrounding the urethra. Following gadolinium administration, it shows no enhancement while submucosal region enhances. It is often difficult to distinguish periurethral cyst with urethral diverticulum, however the communication between the lesion and urethra is often diagnostic of diverticulum, which may not be seen in all cases. Surgical intervention is the most effective treatment and is aimed at complete excision depending upon symptom, extent, invasion of surrounding structures, size and location of urethral diverticulum.