Urethral diverticula: Diagnosis and treatment

Kasyan G.R., Pushkar D.U., Anisimov A.V.
Clinic of Urology MSMSU

Introduction & Objectives: The aim of the study is to analyze the role of additional investigations, like MRI. in patients with urethral diverticulae when the diagnosis is not clear with routine examinations.

Table 1. The reasons for referring to Urology Clinic in female patients with urethral diverticulae

Material & Methods: The study included 73 patients with urethral diverticulae. The mean age of these patients was 33,7 years. An average period of time from diagnosing to hospitalization was 8,2 months. The main complaints of the patients related to diverticulae are included in the table below.

Results: In 3 cases from 73 (4,1%) we have met a rare condition that is giant urethral diverticulae. The size of diverticula does not allow differentiating it from the cystocele or bladder diverticula with physi­cal exam only. In 3 patients (4,1%) we found multiple diverticulae on Usound examination. Usound followed by MRI was utilized in 15 pa­tients suffering urethral diverticulae. In 7 patients from 15 we have used endorectal probe on MRI examinations. These methods allowed us to visualize the diverticula and confirm the diagnosis. In all cases when endorectal MRI was utilized, we have found a dislocation of the diverticula due to insertion of endorectal probe. Figure 1: MRI of mul­tiple urethral diverticulae (above); MRI with rectal probe deforms the diverticula (below)

Conclusions: Utilization MRI helps to make clear the anatomy of diverticula in selected cases and shows its relationship to urethra and bladder, which is obviously prognostic for planning surgery. On the same time we have to emphasize that we were not able to visualize the isthmus between urethra and diverticula on endorectal MRI. MRI with endorectal probe does not give any additional information comparing to standard MRI examination.