Cross-sectional imaging of the female urethra

Abstract

Diagnosis of female urethral and periurethral pathology is challenging for clinicians because patients present with nonspecific symptoms. In many cases, these symptoms can be attributed to diagnoses such as urethritis, which have no imaging findings. However, these symptoms may be caused by a variety of lesions, which may be diagnosed by imaging.Conventional imaging studies such as voiding cystourethrography (VCUG) and retrograde double-balloon positive-pressure urethrography have played a limited role in diagnosis. The development of endovaginal sonography and small high-frequency phased-array US transducers has enabled a more comprehensive evaluation of the static and dynamic relationships between urethral and periurethral tissues. MRI has further advanced the imaging of the female urethra, vagina, perineum, and pelvic floor by enabling high contrast, multiplanar static and dynamic imaging of the entire pelvis. The utility of CT is limited predominantly to the assessment of urethral calculi.This chapter first reviews the normal anatomic appearance of the urethra and adjacent structures. Next, the use of sonography and MRI in the evaluation of urethral pathology is discussed. Algorithms for a pattern-recognition approach to organizing and diagnosing urethral and periurethral pathologic entities based on imaging are presented. Urethral pathologic entities are reviewed in regards to pathogenesis, clinical presentation, diagnosis, imaging features, treatment, and prognosis. Both benign and malignant urethral and periurethral pathology are discussed. Pelvic floor dysfunction is briefly reviewed.