MRI of the Urethra in Women with Lower Urinary Tract Symptoms: Spectrum of Findings at Static and Dynamic Imaging

Genevieve L. Bennett; Elizabeth M. Hecht; Teerath Peter Tanpitukpongse; James S. Babb; Bachir Taouli; Samson Wong; Nirit Rosenblum; Jamie A. Kanofsky; Vivian S. Lee

Disclosures

Am J Roentgenol. 2009;193(6):1708-1715. 

In This Article

Abstract and Introduction

Abstract

Objective. The purpose of our study was to determine the findings at both static and dynamic MRI in women with a clinically suspected urethral abnormality.
Materials and methods. MRI of the urethra was performed in 84 women with lower urinary tract symptoms using multiplanar T2-weighted turbo spin-echo and unenhanced and contrast-enhanced gradient-echo sequences. A dynamic true fast imaging with steady-state free precession sequence was performed during straining in the sagittal plane. Images were evaluated by two radiologists for urethral pathology and pelvic organ prolapse. MRI findings were correlated with clinical symptoms using the Fisher's exact and Mann-Whitney tests.
Results. Urethral abnormalities were found in 10 of 84 patients (11.9%), including two urethral diverticula, five Skene's gland cysts or abscesses, and three periurethral cysts. Thirty-three patients (39.3%) were diagnosed with pelvic organ prolapse, of whom 29 (87.9%) were diagnosed exclusively on dynamic imaging. In 29 of 33 patients with prolapse (87.9%), the urethra was structurally normal. MRI showed 13 cystoceles and 17 cases of urethral hypermobility not detected on physical examination. Patients with a greater number of vaginal deliveries, stress urinary incontinence, frequency of voiding, and voiding difficulty were statistically more likely to have anterior compartment prolapse (p < 0.05).
Conclusion. Including a dynamic sequence permits both structural and functional evaluation of the urethra, which may be of added value in women with lower urinary tract symptoms. Dynamic MRI allows detection of pelvic organ prolapse that may not be evident on conventional static sequences.

Introduction

The clinical diagnosis of structural abnormalities of the female urethra, such as urethral diverticulum and Skene's gland abscess, may be challenging because these abnormalities are often associated with a wide range of nonspecific clinical symptoms and often are not detectable at physical examination.[1,2] The advantages of MRI for diagnosis of urethral abnormalities in women with lower urinary tract symptoms have been well established.[3–6] Compared with conventional imaging methods, such as voiding cystourethrography and double-balloon catheter urethrography, MRI offers a noninvasive method of evaluating the female urethra that requires no patient preparation. High-resolution multiplanar MRI permits visualization of detailed urethral and bladder anatomy and pathology with excellent soft-tissue contrast.

Pelvic floor weakness resulting in anterior compartment prolapse may be associated with lower urinary tract symptoms, such as urinary incontinence. These symptoms may overlap with those of structural abnormalities of the urethra. For instance, a urethral diverticulum may be associated with urinary incontinence due to weakening of the urethral sphincter; however, incontinence may also result from weakening of the pelvic floor support structures, causing bladder descent and urethral hypermobility.[7] Furthermore, pelvic organ prolapse is often multicompartmental.[8,9] Dynamic MRI using ultrafast sequences and performed during strain maneuvers is an effective and noninvasive method for evaluation of organ prolapse in all three compartments of the pelvic floor.[10–23] Dynamic MRI has been shown to be especially effective in the functional assessment of the urethra in patients with urinary incontinence, allowing detection of bladder neck and urethral motion.[7,24]

The purpose of this retrospective study was to determine the spectrum of imaging findings at both static and dynamic MRI performed in women with lower urinary tract symptoms and a clinically suspected urethral abnormality. Our aim was to determine whether this approach allows a more comprehensive evaluation of the woman with lower urinary tract symptoms through the detection of both structural and functional abnormalities of the urethra and coexisting pelvic organ prolapse.

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