London Borough of Sutton - Justification for Exemption for Sutton
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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
http://pubs.rsna.org/doi/full/10.1148/rg.24
si045504
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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
http://pubs.rsna.org/doi/full/10.1148/rg.24
si045504
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RADIOGRAPHIC FEATURES Double ballon uretrography
Voiding Cystourethrography
US
CT Voiding Uretrography MRI
http://pubs.rsna.org/doi/full/10.1148/rg.24
si045504
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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
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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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
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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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.