Urethral diverticulum

A 45-year-old female with a 3 month history of dyspareunia and urinary urgency.

MRI shows a septated U-shaped T2-hyperintense lesion (blue arrows, Fig. 1, 3) surrounding the posterior aspect of the urethra (red arrow, Fig. 1, 2) at the level of the pubic symphysis.

Urethral diverticulum is a focal dilatation of the wall of the urethra, which is in communication with the urethral lumen [1], and is common at patients between 30-50 years old [2].
Clinical findings are: dysuria, dyspareunia and drip post voiding [3].
MRI shows a cystic lesion, high T2/low T1 signal intensity, arising from the posterolateral aspect of the urethra at the level of the pubic symphysis, usually surrounding in different degrees the urethra [3].
If there is debris, it could show a high signal intensity on T1.
Post-contrast images and diffusion help to detect inflammatory changes or associated malignant lesions [1].
Surgical planning requires to evaluate the location (using clock template in axial plane), size, configuration (simple or multicystic appearance) and position of the neck [3, 4].