Urethral diverticulum adenocarcinoma

Last revised by Dr Matt A. Morgan on 03 Jun 2016

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.

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 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.

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Cases and figures

  • Case 1
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