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Updated: Jun 2, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
MRI of acquired posterior urethral diverticulum following surgery for anorectal malformations
Daniel J Podberesky1, Nicholas C Weaver, Christopher G Anton
1Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229, USA. Daniel.podberesky@cchmc.org
Background:
Posterior urethral diverticulum (PUD) is one of the most common postoperative complications associated with anorectal malformation (ARM) correction.
Objective:
To describe our MRI protocol for evaluating acquired PUD following ARM surgery, and associated imaging findings.
Materials And Methods:
Two radiologists retrospectively reviewed 61 pelvic MRI examinations performed for postoperative ARM for PUD identification and characteristics. Associated clinical, operative and cystoscopy reports were also reviewed and compared to MRI.
Results:
An abnormal retrourethral focus suspicious for PUD was identified at MRI in 13 patients. Ten of these patients underwent subsequent surgery or cystoscopy, and PUD was confirmed in five. All of the confirmed PUD cases appeared as cystic lesions that were at least 1 cm in diameter in two imaging planes. Four of the false-positive cases were punctate retrourethral foci that were visible only on a single MRI plane. One patient had a seminal vesical cyst mimicking a PUD.
Conclusion:
Pelvic MRI can be a useful tool in the postoperative assessment of suspected PUD associated with ARM. Radiologists should have a high clinical suspicion for a postoperative PUD when a cystic lesion posterior to the bladder/posterior urethra is encountered on two imaging planes in these patients.
Insights
Pelvic MRI can detect posterior urethral diverticulum (PUD) after anorectal malformation (ARM) surgery. Look for cystic lesions over 1 cm in two planes to confirm PUD diagnosis.
Area of Science:
- Radiology
- Urology
- Pediatric Surgery
Background:
- Posterior urethral diverticulum (PUD) is a frequent complication following anorectal malformation (ARM) correction surgery.
- Accurate diagnosis of PUD is crucial for appropriate patient management.
Purpose of the Study:
- To detail a magnetic resonance imaging (MRI) protocol for identifying acquired PUD post-ARM surgery.
- To characterize the imaging findings associated with PUD in this patient population.
Main Methods:
- Retrospective review of 61 pelvic MRI scans in patients who underwent ARM surgery.
- Correlation of MRI findings with clinical, operative, and cystoscopy reports.
- Radiologist assessment for PUD identification and characteristic features.
Main Results:
- MRI identified suspicious retrourethral foci in 13 patients; PUD was confirmed in 5 of 10 subsequent evaluations.
- Confirmed PUD lesions measured at least 1 cm in diameter across two imaging planes.
- False-positive findings included single-plane punctate foci and a seminal vesicle cyst.
Conclusions:
- Pelvic MRI is a valuable tool for postoperative assessment of suspected PUD in ARM patients.
- High clinical suspicion is warranted for cystic lesions posterior to the bladder/urethra on two MRI planes.
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