SUTTON FINAL.pdf

8/18/2019 SUTTON FINAL.pdf

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Sutton Textbook Reading

Page 1021

Pembimbing : dr. Yana Supriatna, PhD, Sp.RadPresentan : Muhammad Ichsan Noorhadi


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• A length of 17 to 20 cm

• Runs from the bladder neck to

Orificium Urethra Externa

•Consists of:

1. Posterior- Prostatic

- Membranous

2. Anterior

- Bulbar

- Penile

http://pubs.rsna.org/doi/full/10.1148/rg.24

si045504

Male Urethra


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•Extends from bladder

neck obliquely in an

anterior and inferiordirection to the external

orifice situated between

the labia minora

•4 cm

•Many small

periurethral glandsopen into the urethra

Female Urethra


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INTRODUCTION

Urethral diverticulum is a focal

outpouching, “sac like” of the urethra

More commonly in women than in men

Rare

http://www.ncbi.nlm.nih.gov/pubmed/19001648

http://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-

8/fulltext

http://www.ncbi.nlm.nih.gov/pubmed/19001648http://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/19001648http://www.ncbi.nlm.nih.gov/pubmed/19001648http://www.ncbi.nlm.nih.gov/pubmed/19001648http://www.ncbi.nlm.nih.gov/pubmed/19001648


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•In female Most diverticula are

located on the posterolateral wall

of the urethra

• Incidence 0.6-6%, particulary 30-

60 years of age

•black women are six times more

often affected than white women

http://www.ncbi.nlm.nih.gov/pubmed/19001648

•Anatomical appearance

of congenital diverticula

•260 patients over a

20 year period

http://www.clinicalradiologyonline.net/article/S0009

-9260%2813%2900085-8/fulltext

http://www.ncbi.nlm.nih.gov/pubmed/19001648http://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.ncbi.nlm.nih.gov/pubmed/19001648


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ETIOLOGY

URETHRAL

DIVERTICULA

Congenital

Infection

Trauma

http://www.clinicalradiologyonline.net/article/S0009-

9260%2813%2900085-8/fulltext

http://www.clinicalradiologyonline.net/article/S0009-9260(13)00085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260(13)00085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260(13)00085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260(13)00085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260(13)00085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260(13)00085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260(13)00085-8/fulltext


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P ATHOGENESIS OF A FEMALE URETHRAL

DIVERTICULUM

(a) obstructionof a duct of Skene (*) leads to dilatation and abscess(A) of a paraurethral gland.U = urethra.

(b) rupture of the paraurethral gland abscess (A) into the lumen of

the urethra (U) (arrow), with subsequent formation of a

diverticulum


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URETHRAL DIVERTICULUM ANATOMY

https://www.clinicalkey.com.ezproxy.ugm

.ac.id/#!/content/book/3-s2.0-

B978145577567500090X


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CLINICAL PRESENTATION

Three D

d ysuria (30-70%), postvoid d ribbling(10-30%),

and d yspareunia(10-25)

Frekuensi (40-100%)

Haematuria (10-25)

Purulent discharge from the urethra

anterior vaginal wall mass may be identified at

physical examination2-11% asymtomatic


si045504


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RADIOGRAPHIC FEATURES Double ballon uretrography

Voiding Cystourethrography

US

CT Voiding Uretrography MRI


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DOUBLE BALLON URETROGRAPHY Advantages : Passive filling with

contrast agent at a higher pressure

Disadvantages : Technically difficult,

requires a specialized catheter,

uncomfortable for the patient, risk of

urethral injury

Sensitivity: High (


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VOIDING C YSTOURETHROGRAPHY

Advantages : Technically easy

and simple

Disadvantages : ionizing radiation

Sensitivity: moderate (70%-90%)Specitifity : High (


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Advantages : Noninvasive, no

ionizing radiation

Disadvantages : Insensitive for small

diverticula, operator dependent,

Sensitivity: High (70%)

Major Findings : Periurethral cystic lesion with

an orifice that communicates with the urethrallumen

ULTRASONOGRAPHY

http://www.clinicalradiologyonline.net/article/

S0009-9260%2813%2900085-8/fulltext

http://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltexthttp://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltext


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ULTRASONOGRAPHY

(a) Transverse transabdominal US

image shows a urethral diverticulum(D) with an appearance similar to

that of the male prostate gland. A

fluid-debris level (arrows) is seen in

the diverticulum.

(b) Sagittal transperineal US

Arrows indicate the fluid-debris levelin the diverticulum

http://www.clinicalradiologyonline.net/article/S0009

-9260%2813%2900085-8/fulltext



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CT VOIDING URETEROGRAPHY

Advantages : Combine voiding

cystourethrographic

and CT techniques, yield two-

dimensional (2D) and three-

dimensional (3D) reformatted images

and simulated virtual endoscopic

images.

Disadvantages :ionizing radiation, extra

time required for postprocessing onworkstation, high cost

Sensitivity: High (


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MRI

Advantages : High-resolution

images for periurethral

structures and diseases,

very sensitive for smaller(1 – 5-mm)

Disadvantages : High cost, time

consuming, endoluminal

coil somewhat invasive and not widelyavailable

Sensitivity : High (


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MRI

Surface coil T2 magnetic resonance

image demonstrating a urethral

diverticulum (arrows) in the sagittal (A)

and axial (B) planes. http://www.clinicalradiologyonline.net/article/S0009-9260%2813%2900085-8/fulltext



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QUIZ

a 45-year-old woman who presented

with dysuria and recurrent urinary

tract infection. Voiding

cystourethrogram shows a multilocular

diverticulum filled with contrast agent

(arrows) at the level of the midurethra.

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