Imaging of female urethral diverticulum: an update

Female urethral diverticulum is an uncommon pathologic entity and can manifest with a variety of symptoms involving the lower urinary tract. Selection of the appropriate imaging modality is critical in establishing the diagnosis. Urethrography has traditionally been used in the evaluation of urethral diverticulum but provides only intraluminal information. Ultrasonography is advantageous in that it does not involve ionizing radiation and has the capacity to help detect a diverticulum without contrast agent filling. Multidetector computed tomographic (CT) voiding urethrography yields urethral images during micturition. In addition, the diverticulum and diverticular orifice can be visualized on two- and three-dimensional reformatted CT images. Interactive virtual urethroscopy provides simulated visualization of the intraluminal anatomy and the diverticular orifice. New magnetic resonance imaging techniques that make use of a surface or endoluminal coil have higher diagnostic accuracy and can delineate the diverticular cavity and help detect related complications. Clinicians should consider the possibility of a urethral diverticulum in women with chronic or recurrent lower urinary tract symptoms. Moreover, because female urethral diverticulum is becoming more prevalent in clinical practice, radiologists should be familiar with its imaging features and with the imaging techniques that are optimal for its evaluation.