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Introduction and Hypothesis: Studies on the imaging of female periurethral masses are sparse, and most are focused on cystic lesions. In this article, we studied female periurethral solid masses and reported their ultrasonographic features., Methods: Fifteen women with periurethral solid masses pathologically diagnosed between January 2008 and April 2021 were assessed., Results: Each patient had only one mass. The pathological types included urethral caruncle (5 patients), urethral leiomyoma (3 patients), urethral malignant tumor (MT) (3 patients), periurethral spindle tumor (3 patients) and cartilage necrosis of pubic symphysis (PS) (1 patient). On ultrasound, all urethral caruncles were located at the urethral meatus. They were hypoechoic/isoechoic and rich in blood flow signal. Each leiomyoma presented as a well-defined hypoechoic mass with an oval shape. The urethral MT had inhomogeneous/isoechoic echoes, with medium to abundant blood flow signal. The spindle cell tumors had regular/irregular shapes, moderate/high density echogenicity and little/rich blood flow signals. The articular cartilage necrosis of PS was regular in shape, with mixed echogenicity and no blood flow., Conclusions: Ultrasound imaging is a convenient and useful method to evaluate the morphological characteristics of female periurethral solid masses., (© 2022. The International Urogynecological Association.)

Introduction and Hypothesis: Urethral diverticulum in pregnancy is a rare finding and difficult to diagnose. The classical triad of dysuria, dyspareunia and dribbling of urine is found in a minority of women., Methods: A young woman presented during the first trimester of pregnancy with vaginal and suprapubic pain as well as voiding difficulty. Ultrasound demonstrated a 2-cm hypoechoic lesion to the left of the urethra. She went on to have a cystoscopy that demonstrated a diverticulum. She was found to have chlamydia on PCR., Results: Her pregnancy was complicated by recurrent admissions for pain and also an episode of reactive arthritis. She underwent an uncomplicated surgical excision postpartum., Conclusions: Urethral diverticula should be excluded whenever a patient exhibits unresolved, nonspecific urinary problems. This is an underdiagnosed problem. Pregnancy presents additional challenges, but does not preclude medical or surgical treatment in the patient with significant symptoms.

Introduction and Hypothesis: Accurate diagnosis of a wide spectrum of urethral/periurethral pathologies in women remains challenging due to its anatomical location and nonspecific clinical presentations. Magnetic resonance imaging (MRI) has emerged as the modality of choice for diagnosing female urethral and periurethral pathologies due to its multiplanar scanning capability, superior soft tissue differentiation, noninvasive nature, and overall excellent contrast resolution., Methods: In this narrative review, we describe the use of MRI to visualize the female urethra and periurethral pathologies., Results: MRI can confidently characterize lesions into cystic or solid, provide a more succinct differential diagnosis, and in some cases provide a specific and accurate diagnosis, enabling surgeons to prepare a roadmap before operative procedure. Moreover, functional MRI can be useful to assess dynamic disorders such as urethral hypermobility., Conclusions: We provide a comprehensive review of normal MR anatomy of the female urethra, as well as the MR features of practically important urethral and periurethral lesions.

Introduction and Hypothesis: This study investigated the value of transvaginal contrast-enhanced sonourethrography for the diagnosis of female urethral diverticulum (UD) by comparing results of contrast-enhanced ultrasound images and surgical findings., Methods: A total of 14 female UD patients underwent preoperative transvaginal contrast-enhanced sonourethrography between July 2010 and June 2012. History and physical examination were initially assessed by the same urologist. Transvaginal contrast-enhanced ultrasound imaging was performed and interpreted by the same ultrasonographer. Definite diagnosis was made by tracking the flow of the microbubbles into the cyst. Additionally, sagittal, cross-sectional, and dynamic images were obtained, and color Doppler ultrasound was applied in all cases. Data on the size, location, configuration, and opening of the UD was documented, and then compared with the surgical findings., Results: The most common symptoms presenting in the UD patients included urinary incontinence (71.5 %), recurrent urinary tract infection (57.1 %), frequency (50 %), urgency (35.7 %), dysuria (35.7 %), and dyspareunia (21.4 %). On physical examination, 8 out of 14 patients (57.1 %) had a palpable anterior vaginal wall mass, while 6 out of 14 patients (42.9 %) had no palpable mass. Transvaginal contrast-enhanced sonourethrography revealed 17 diverticula orifices in total and correlated well with surgical findings regarding the size, location, configuration, and the opening of the UD., Conclusions: In patients with chronic irritative bladder symptoms, but with no response to conventional treatment a high index of suspicion for UD should be maintained. Our study demonstrates that transvaginal contrast-enhanced sonourethrography is a useful tool for defining the size, location, configuration, and opening of the UD before surgery.

Urethral prolapse is an uncommon clinical condition that is reported predominantly in children and postmenopausal women. We describe a case of a 39-year-old woman who presented at the emergency room with vaginal bleeding and pain related to Valsalva maneuver (lifting weight). She described several similar previous episodes, which started during her second pregnancy at 32 years of age. The episodes initially occurred every 6 months, but she did not seek medical assistance for 7 years, during which time symptoms became more frequent. She had no previous history of irradiation, pelvic infection, or urogenital surgery. During physical examination, a urethral prolapse was identified. Pelvic and urinary ultrasound (US) showed no other abnormality. The patient underwent cystourethroscopy and surgical excision of the urethral prolapse, with complete resolution of symptoms. Histopathology confirmed benign inflammatory urethral mucosa tissue with edema and vascular congestion.

Introduction and Hypothesis: Our purpose was to assess the accuracy of history and physical, cystourethroscopy, and magnetic resonance imaging (MRI) in preoperative diagnosis of urethral diverticula., Methods: This was a retrospective review of all patients who underwent surgical excision of periurethral masses between 1998 and 2009. Presenting symptoms and examination and cystourethroscopic findings were noted. A single pathologist reviewed all cases and provided the reference standard for the diagnosis of a diverticulum. A single radiologist reviewed all preoperative MRI studies. Sensitivities, specificities, and positive and negative predictive values (PPV, NPV) were determined., Results: Diverticula were diagnosed in 36/60 (60 %) patients. Transurethral fluid expression on palpation and recurrent urinary tract infection (UTI) had high PPV. Sensitivity, specificity, PPV, and NPV, respectively, for cystourethroscopy were 33 %, 100 %, 100 %, and 42 %; for MRI, these were 100 %, 83 %, 92 %, and 100 %., Conclusion: These data reinforce the utility of transurethral fluid expression for preoperative evaluation of urethral diverticula. Additionally, MRI is an excellent adjunctive diagnostic tool and may assist in establishing the diagnosis when there is high clinical suspicion of a urethral diverticulum but nonconfirmatory findings on cystourethroscopy.

A 56-year-old female smoker presented after long diagnostic delay with high-grade transitional cell carcinoma in situ within a urethral diverticulum. This is the third report of this type in the literature. Preoperative investigations, including urine cytology and magnetic resonance imaging (MRI), were not helpful.

Urodynamic testing is a widely used modality for evaluation of lower urinary tract symptoms with minimal morbidity to the patient. We report a case of strangulated urethral prolapse in a 74-year-old female that occurred right after urodynamic evaluation. The urethral prolapse was managed conservatively and the patient fully recovered without the need for surgical intervention.

Vaginal pessaries are safe, simple and effective treatment for pelvic organ prolapse. However, they must be fitted and followed-up correctly as serious complications can arise when pessaries are neglected. In this case report, we present the first reported case of a urethrovaginal fistula due to a neglected shelf pessary.

Urethral bulking agents are a commonly employed modality utilized for treatment of female stress urinary incontinence. These primarily collagen-based agents are placed in the proximal urethra to facilitate mucosal coaptation during increases of intra-abdominal stress. Several known complications of these agents exist, including urethral prolapse, retention, and urinary infection. Herein, we report two cases diagnosed as urethral diverticuli which were ultimately determined anatomic aberration secondary to prior bulking agent therapy. Recognition of this potential sequela of bulking agent placement is important for the female pelvic surgeon to recognize to avoid the morbidity of potential invasive interventions.

Introduction and Hypothesis: This study seeks to evaluate axial variation, comparisons with current technology, performance during dynamic conditions, and patient tolerability of the urethral sleeve sensor (USS) for maximal urethral closure pressure (MUCP) measurements., Methods: Eighteen continent and seven stress incontinent women underwent assessments with USS and urethral pressure profilometry (UPP) in random order. Intravesical (p (ves)) and urethral (p (ura)) pressure signals were collected and urethral closure pressure (p (clo)) was calculated. A visual analog scale (VAS) was used to evaluate subject discomfort., Results: The correlation coefficient between MUCP obtained by UPP and USS techniques was 0.86 (p < 0.001). Higher USS pressures were obtained with catheter oriented to 12 o'clock. Continent subjects demonstrated higher values of p (clo). MUCP became <0 cm H(2)O in subjects with clinical leakage during Valsalva, but not in continent subjects. Subjects tolerated the USS technique better than the UPP technique on VAS (p < 0.001)., Conclusions: USS technology can be used to evaluate the urethra in both static and dynamic conditions and is better tolerated than withdrawal techniques.