Imaging the Female Urethra: US and MRI in Cystic and Solid Pathologic Conditions

The female urethra can be affected by numerous pathologic conditions, many of which are infrequent and often underdiagnosed, particularly before the introduction of MRI. Diagnosing urethral pathologic conditions is challenging due to ambiguous signs and symptoms, nonspecific physical examinations, atypical presentations (such as benign conditions mimicking malignant disorders), and large lesions. Various imaging techniques, including transperineal or transvaginal US and MRI, are essential for accurate anatomic and tissue characterization. Female urethral pathologic conditions can be categorized into cystic lesions (with urethral diverticulum as the most common), benign and malignant solid urethral lesions, and iatrogenic lesions. Defining the location of the pathologic finding is the first step in radiologic diagnosis. By analyzing tissue characteristics (cystic versus noncystic), shape, morphology, and location (including urethral dependence and relationship to the pubic symphysis), an accurate diagnosis can often be achieved. Identifying whether a lesion is urethral-dependent helps distinguish between urethral and other conditions, such as Bartholin gland and Gartner duct cysts. Radiologists must recognize these features to determine the most appropriate diagnostic and therapeutic strategies. ^©RSNA, 2025 Supplemental material is available for this article.