Original Article

Pediatric Radiology

, Volume 41, Issue 9, pp 1139-1145

First online:

MRI of acquired posterior urethral diverticulum following surgery for anorectal malformations

  • Daniel J. PodbereskyAffiliated withDepartment of Radiology, Cincinnati Children’s Hospital Medical Center Email author 
  • , Nicholas C. WeaverAffiliated withDepartment of Radiology, Cincinnati Children’s Hospital Medical CenterVanderbilt University
  • , Christopher G. AntonAffiliated withDepartment of Radiology, Cincinnati Children’s Hospital Medical Center
  • , Taiwo LawalAffiliated withDepartment of Surgery, Cincinnati Children’s Hospital Medical CenterDepartment of Surgery, University College Hospital
  • , Miller C. HamrickAffiliated withDepartment of Surgery, Cincinnati Children’s Hospital Medical Center
  • , Shumyle AlamAffiliated withDepartment of Urology, Cincinnati Children’s Hospital Medical Center
  • , Alberto PeñaAffiliated withDepartment of Surgery, Cincinnati Children’s Hospital Medical Center
  • , Marc A. LevittAffiliated withDepartment of Surgery, Cincinnati Children’s Hospital Medical Center

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Abstract

Background

Posterior urethral diverticulum (PUD) is one of the most common postoperative complications associated with anorectal malformation (ARM) correction.

Objective

To describe our MRI protocol for evaluating acquired PUD following ARM surgery, and associated imaging findings.

Materials and methods

Two radiologists retrospectively reviewed 61 pelvic MRI examinations performed for postoperative ARM for PUD identification and characteristics. Associated clinical, operative and cystoscopy reports were also reviewed and compared to MRI.

Results

An abnormal retrourethral focus suspicious for PUD was identified at MRI in 13 patients. Ten of these patients underwent subsequent surgery or cystoscopy, and PUD was confirmed in five. All of the confirmed PUD cases appeared as cystic lesions that were at least 1 cm in diameter in two imaging planes. Four of the false-positive cases were punctate retrourethral foci that were visible only on a single MRI plane. One patient had a seminal vesical cyst mimicking a PUD.

Conclusion

Pelvic MRI can be a useful tool in the postoperative assessment of suspected PUD associated with ARM. Radiologists should have a high clinical suspicion for a postoperative PUD when a cystic lesion posterior to the bladder/posterior urethra is encountered on two imaging planes in these patients.

Keywords

Anorectal malformation Posterior urethral diverticulum Children MRI