DOI: 10.1148/rg.253045067
Cross-sectional Imaging of the Female Urethra: Technique and Results1
Srinivasa R. Prasad, MD,
Christine O. Menias, MD,
Vamsi R. Narra, MD,
William D. Middleton, MD,
Govind Mukundan, MD,
Nayer Samadi, RMDS,
Jay P. Heiken, MD and
Cary L. Siegel, MD
1 From the Department of Radiology, University of Texas Health Science Center, 7703 Floyd Curl Dr, San Antonio, TX 78229 (S.R.P.); and the Department of Radiology, Mallinckrodt Institute of Radiology, St Louis, Mo (C.O.M., V.R.N., W.D.M., G.M., N.S., J.P.H., C.L.S.). Recipient of a Certificate of Merit award and an Excellence in Design award at the 2002 RSNA Scientific Assembly. Received April 12, 2004; revision requested July 27 and received October 19; accepted October 20. All authors have no financial relationships to disclose.
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Figure 1. Normal cross-sectional anatomy of the urethra. Coronal cross-sectional diagram shows the relationship of the urethra to the vagina and rectum. The urethropelvic ligaments provide structural support to the urethra.
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Figure 2. Normal surface anatomy of the vulva and vagina. Diagram shows the relationship between the urethra and the ducts of the Skene glands and greater vestibular glands.
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Figure 3a. Urethral anatomy at sonography. (a, b) Sagittal transvaginal (a) and transperineal (b) sonograms show normal urethral anatomy. Straight arrow = urethra, curved arrow = bladder. (c) Transurethral sonogram obtained by using a catheter-based high-frequency transducer shows a urethral diverticulum (arrow). Note the neck of the diverticulum (arrowhead). (Fig 3c reprinted, with permission, from reference 4.)
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Figure 3b. Urethral anatomy at sonography. (a, b) Sagittal transvaginal (a) and transperineal (b) sonograms show normal urethral anatomy. Straight arrow = urethra, curved arrow = bladder. (c) Transurethral sonogram obtained by using a catheter-based high-frequency transducer shows a urethral diverticulum (arrow). Note the neck of the diverticulum (arrowhead). (Fig 3c reprinted, with permission, from reference 4.)
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Figure 3c. Urethral anatomy at sonography. (a, b) Sagittal transvaginal (a) and transperineal (b) sonograms show normal urethral anatomy. Straight arrow = urethra, curved arrow = bladder. (c) Transurethral sonogram obtained by using a catheter-based high-frequency transducer shows a urethral diverticulum (arrow). Note the neck of the diverticulum (arrowhead). (Fig 3c reprinted, with permission, from reference 4.)
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Figure 4. Normal urethral anatomy at endovaginal MR imaging. Axial gadolinium-enhanced T1-weighted three-dimensional gradient-echo image shows a normal urethra (arrow). Note the endovaginal coil (C) and pubourethral ligaments (arrowhead).
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Figure 5. Complex urethral diverticulum in a 48-year-old woman with urethral syndrome. Coronal transvaginal sonogram shows a complex multicompartment diverticulum (arrows). (Reprinted, with permission, from reference 4.)
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Figure 6. Complex urethral diverticulum in a 53-year-old woman. Axial endovaginal T2-weighted MR image shows a multilocular urethral diverticulum (arrows).
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Figure 7. Complex circumferential urethral diverticulum. Axial gadolinium-enhanced fat-saturated T1-weighted MR image shows a circumferential diverticulum (arrows) with two necks at the 5- and 9-o’clock positions (arrowheads). This type of diverticulum is difficult to completely excise and prone to recurrence.
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Figure 8. Complex urethral diverticulum. Sagittal transvaginal sonogram shows a multilocular diverticulum with echogenic debris (arrow).
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Figure 9a. (a) Coronal transvaginal sonogram of a 47-year-old woman with a urethral mass shows calculi (arrowhead) within a diverticulum (arrow). (b) Axial endovaginal T2-weighted MR image of a 52-year-old woman with dysuria shows calculi (arrowhead) within a complex diverticulum (arrow).
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Figure 9b. (a) Coronal transvaginal sonogram of a 47-year-old woman with a urethral mass shows calculi (arrowhead) within a diverticulum (arrow). (b) Axial endovaginal T2-weighted MR image of a 52-year-old woman with dysuria shows calculi (arrowhead) within a complex diverticulum (arrow).
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Figure 10. Malignancy within a urethral diverticulum. Axial gadolinium-enhanced endovaginal fat-saturated T1-weighted gradient-echo MR image shows a large polypoid adenocarcinoma (straight arrow) within a urethral diverticulum (curved arrow).
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Figure 11a. Urethral leiomyoma. (a) Sagittal transvaginal sonogram shows a large urethral mass with uniform echotexture. U = urethra. (b) Coronal transvaginal sonogram shows that the mass has marked vascularity.
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Figure 11b. Urethral leiomyoma. (a) Sagittal transvaginal sonogram shows a large urethral mass with uniform echotexture. U = urethra. (b) Coronal transvaginal sonogram shows that the mass has marked vascularity.
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Figure 12. Urethral leiomyoma. Axial gadolinium-enhanced endovaginal fat-saturated T1-weighted gradient-echo MR image shows a heterogeneously enhancing mass (arrow).
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Figure 13a. Biopsy-proved squamous cell carcinoma in a patient with a urethral mass. (a) Sagittal transvaginal sonogram shows a large, lobulated, isoechoic urethral mass. Arrow = bladder. (b) Transperineal sonogram shows that the mass has increased vascularity.
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Figure 13b. Biopsy-proved squamous cell carcinoma in a patient with a urethral mass. (a) Sagittal transvaginal sonogram shows a large, lobulated, isoechoic urethral mass. Arrow = bladder. (b) Transperineal sonogram shows that the mass has increased vascularity.
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Figure 14. Transitional cell carcinoma within a urethral diverticulum. Axial gadolinium-enhanced fat-saturated T1-weighted gradient-echo MR image shows a serpiginous, heterogeneously enhancing mass (curved arrow) within a complex urethral diverticulum (straight arrow).
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Figure 15. Urethral adenocarcinoma. Coronal high-resolution endovaginal T2-weighted MR image shows a large, concentric urethral mass with significant peri-urethral extension (arrow).
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Figure 16. Urethral spread of an anal adenocarcinoma. Axial gadolinium-enhanced fat-saturated T1-weighted gradient-echo MR image shows an ill-defined lesion (arrow) contiguous to the urethra.
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Figure 17. Changes due to collagen injection. Coronal transvaginal sonogram shows paraurethral echogenic lesions from injected collagen (cursors). Collagen is injected into the periurethral tissues in patients with stress urinary incontinence.
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Figure 18. Changes due to injection of carbon-coated beads. Sagittal transvaginal sonogram shows periurethral calcifications (arrow), which were due to injection of carbon-coated beads for treatment of stress urinary incontinence.
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Figure 19. Suture granulomas. Sagittal transperineal sonogram shows discrete echogenic foci (arrow), which represent suture granulomas.
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Figure 20. Ectopic ureter in a woman with duplication of the collecting system and ureter who presented with urinary incontinence. Sagittal transvaginal color Doppler sonogram shows an ectopic ureter (straight arrow) emptying into the urinary bladder (curved arrow).
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Figure 21. Gartner cyst. Sagittal transperineal sonogram shows a cyst with uniform internal echoes in the region of the distal urethra. Note that most diverticula occur in the midurethra. Arrow = urethra.
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Figure 22. Coronal cross-sectional diagram shows the relationship of the Gartner cyst to the vagina.
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Figure 23. Skene cyst in a patient with a urethral mass. Axial T2-weighted MR image shows a complex periurethral cyst with a fluid-fluid level due to hemorrhage (arrow).
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Copyright © 2005 by the Radiological Society of North America.
