Imaging of urethral and sub-urethral masses - The University Hospitals of North Midlands NHS Trust experience

Rameesha Anwar, University Hospital North Midlands NHS Trust

Swelling around the urethra and vagina is a common clinical presentation in females and can represent a range of differentials including female urethral diverticulum and periurethral masses. Patients often present with non-specific signs and symptoms and physical examination can be unreliable. Although distinguishing between urethral and vaginal wall masses can be clinically challenging, it impacts on whether a gynaecology or urology referral is indicated and hence completely alters the patient’s future management. Therefore, being familiar with optimal imaging techniques as well as identifying the key imaging features of urethral and periurethral disease in female patients is an increasing requirement for radiologists.

Imaging the female urethra with magnetic resonance imaging has improved greatly and provides high resolution multiplanar images, allowing for greater diagnostic accuracy. However, there is currently emerging technology using 3D endovaginal ultrasound (EVUS) to assess and evaluate the structures of the pelvic floor and related pathology. In our centre, 3D EVUS is used with a high-frequency (12-16 MHz ) endocavity transducer that provides automatic 360° image acquisition. Providing high 3D resolution and diagnostic ability, we have found that it has, at times, negated the need for costly and time consuming MRI. As the use of 3D EVUS is poorly documented in the literature, the objective of this presentation is to discuss ultrasonographic techniques and its advantages in imaging females with sub-urethral masses. 

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