Urethral diverticulum adenocarcinoma is a rare occurrence in a urethral diverticulum.
Urethral diverticulum seen in ~0.6-6% of women. In small series, only 3-6% of resected urethral diverticula show adenocarcinoma 3-4.
Urinary frequency, urgency, burning micturition and dysuria are usual presenting symptoms or urethral diverticulum 1. There is no specific clinical presentation of adenocarcinoma in a diverticulum.
Urethral diverticulum carcinomas include transitional cell carcinoma, squamous cell carcinoma and adenocarcinoma. Adenocarcinoma is the most common subtype (60%) 2.
Voiding cystourethrogram (VCUG)
Contrast-filled outpouching from urethra with partial filling / contrast retention during voiding. Adenocarcinoma is seen as a filling defect within the diverticulum 2.
Double balloon urethrography
Double balloon urethrography can be used to forcefully inject contrast into diverticular orifice, although its use is now uncommon, if MRI is available.
On transabdominal ultrasound, a distended urethral diverticulum is seen posterior to urinary bladder (in females, it is a similar location to prostate). A carcinoma may present as a polypoidal or diffuse mass lesion within.
Transvaginal or endourethral ultrasound may have a higher sensitivity for detection.
CT is not the preferred modality for evaluation of the pelvis. If the urethral diverticulum is large, it may present as a well-defined thick-walled cystic lesion, at the level of pubic symphysis. A carcinoma may present as an enhancing mass within the diverticulum.
CT would theoretically be able to stages a urethral diverticulum adenocarcinoma, in terms of local or regional invasion, better than ultrasound. It can also easily differentiates diverticular calculi from soft tissue in the diverticulum. Differentiation may be difficult on VCUG.
- T1: diverticulum is seen as hypointense signal area around the urethra, or sometimes as a homogenous hypointense signal enlarged urethra. A carcinoma as heterogenous enhancing mass with thickened wall of diverticulum.
- T2: diverticulum is seen as hyperintense signal area around the urethra
Diverticulum can be well visualized on urethroscopy, if the orifice is well identified.
- calculi in diverticulum (may appear as filling-defect in VCUG)
- vaginal adenocarcinoma
- 1. Kim B, Hricak H, Tanagho EA. Diagnosis of urethral diverticula in women: value of MR imaging. AJR Am J Roentgenol. 1993;161 (4): 809-15. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Chou CP, Levenson RB, Elsayes KM et-al. Imaging of female urethral diverticulum: an update. Radiographics. 28 (7): 1917-30. doi:10.1148/rg.287075076 - Pubmed citation
- 3. Laudano MA, Jamzadeh AE, Dunphy C et-al. Pathologic Outcomes following Urethral Diverticulectomy in Women. Adv Urol. 2014;2014: 861940. doi:10.1155/2014/861940 - Free text at pubmed - Pubmed citation
- 4. Thomas AA, Rackley RR, Lee U et-al. Urethral diverticula in 90 female patients: a study with emphasis on neoplastic alterations. J. Urol. 2008;180 (6): 2463-7. doi:10.1016/j.juro.2008.08.040 - Pubmed citation