Endoluminal magnetic resonance imaging in the evaluation of urethral diverticula in women

Objectives. Accurate determination of the size and extent of urethral diver ticula can be important in planning operative reconstruction and repair. Vo iding cystourethrography (VCUG) is currently the most commonly used study i n the preoperative evaluation of urethral diverticula. We reviewed our expe rience with the use of endoluminal (endorectal or endovaginal) magnetic res onance imaging (eMRI) in these patients as an adjunctive study to VCUG to e valuate whether the MRI provided anatomically important information that wa s not apparent on VCUG. Methods. A retrospective analysis of all patients with a clinical diagnosis of urethral diverticula undergoing MRI at a single institution was perform ed. Patients were evaluated with history, physical examination, cystoscopy, VCUG, and eMRI. Endoluminal MRI was retrospectively compared to VCUG with respect to size, extent, and location found at operative exploration. Results. Twenty-seven consecutive patients underwent endorectal or endovagi nal coil MRI in the evaluation of suspected urethral diverticula. Twenty pa tients subsequently had attempted transvaginal operative repair of the dive rticulum. In 2 patients, eMRI demonstrated a urethral diverticulum, whereas VCUG did not. Operative exploration in these patients revealed a urethral diverticulum. In 14 of 27 patients, the VCUG underestimated the size and co mplexity of the urethral diverticulum as compared to eMRI and operative exp loration. In 13 of 27 patients, the size, location, and extent of the ureth ral diverticulum on VCUG correlated well with the eMRI and/or operative fin dings. Conclusions. We have found endorectal and endovaginal coil MRI to be extrem ely accurate in determining the size and extent of urethral diverticula as compared to VCUG. This information can be critical when planning the approa ch, dissection, and reconstruction of these sometimes complex cases. UROLOG Y 57: 660-665, 2001. (C) 2001, Elsevier Science Inc.