In a woman with postvoid dribbling, dysuria, dyspareunia, and recurrent urinary tract infections, what is the differential diagnosis?
Although clinical presentation can be highly variable, the classic triad of postvoid dribbling, dysuria, and dyspareunia is associated with the diagnosis of urethral diverticulum. MRI is the preferred study of choice for identifying a suspected urethral diverticulum. Typical imaging features include a round or oval structure arising from the posterolateral wall of the midurethra at the level of the pubic symphysis demonstrating T2-weighted hyperintensity ( Figure 38-14 ). A direct connection between the urethra and diverticulum is not typically seen, although the diagnosis is based on location and morphology. Complications of diverticula include stone formation and intradiverticular neoplasms such as adenocarcinoma, transitional cell carcinoma, and squamous cell carcinoma. For these reasons, urethral diverticula are often surgically resected.