Presentation
Post void "dribbling"
Patient Data
On this VCUG, a small diverticulum fills around the urethra with voiding. It has a "saddlebag" morphology, wrapping around the urethra posteriorly, but the larger component is on the right.
Zoomed in RPO image of the urethral diverticulum filling during voiding.
- thick green arrow: course of urine through the urethra
- thin curved green arrow: diverted urine into the urethral diverticulum
- the urine enters a diverticulum posteriorly
- filled blue arrow: pointing to the urethral diverticulum
Zoomed in frontal image of the urethral diverticulum after voiding
- small amount of contrast left in the bladder (post-void residual)
- open blue arrows: pointing to the right and left components of the urethral diverticulum that wraps around the posterior urethra
Case Discussion
Urethral diverticula in women have a variety of appearances, but the "classic" appearance is that of a diverticulum extending posteriorly from the urethra and wrapping around the urethra (which has been described as a "saddlebag" appearance, supposedly imitating a saddle wrapping around the back of a horse).
Urethra diverticula are not always seen on VCUG. It depends on the size of the connection between the urethra and the diverticulum. Double balloon catheters (a balloon at the internal bladder sphincter and one at the introitus) used to be used to build sufficient pressure in the short female urethra in order to push contrast through the diverticulum neck. MRI is more often used now.