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Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst?

  • Kidneys, Ureters, Bladder, Retroperitoneum
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate magnetic resonance imaging findings that differentiate among periurethral bulking agents (primarily collagen), urethral diverticulum, and periurethral cyst.

Methods

We searched our radiologic database retrospectively from 2001 to 2017 for periurethral cystic lesions, identifying a total of 50 patients with 68 lesions. Final diagnoses in 68 lesions were bulking agents (27), urethral diverticula (29), and periurethral cysts (12). Two abdominal radiologists, blinded to clinical history, independently evaluated T1, T2, and post-contrast images. The readers assessed number, morphological features, location, connection to urethra and mass effect, signal intensity, and enhancement for each lesion. Fisher exact test and logistic regression analysis were performed for each univariate significant feature. The operative and pathologic reports were the reference standard.

Results

Magnetic resonance imaging features found more often in bulking agents versus urethral diverticulum were multiple lesions (P = 0.011), upper or upper-mid-urethral location (P ≤ 0.0001), lack of internal fluid/fluid level (P = 0.002), no urethral connection (P = 0.005), T1 isointensity, and T2 mild hyperintensity compared to muscles but lower T2 signal than urine (P < 0.0001). Most cases of urethral diverticula and periurethral cysts were detected at mid- and lower urethra. Urethral diverticula were larger than bulking agents and periurethral cysts (P = 0.005 and P = 0.023) (mean diameter = 24, 16, 15 mm, respectively). Most bulking agents (93%) and urethral diverticula (90%) showed mass effect on urethra, while periurethral cysts (75%) did not (P < 0.0001).

Conclusion

Signal intensity and lesion characterization on magnetic resonance imaging can significantly differentiate bulking agent from urethral diverticulum and periurethral cyst. Radiologists should consider differential diagnosis of a bulking agent, especially when distinguishing characteristics described here are present to prevent incorrect diagnosis and ultimately unnecessary surgical intervention.

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Funding

This study was unfunded.

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Authors and Affiliations

  1. Department of Radiology, Massachusetts General Hospital, Boston, MA, USA

    Thitinan Chulroek, Dearada Wangcharoenrung, Kamonwon Cattapan, Hamed Kordbacheh & Mukesh G. Harisinghani

  2. Department of Diagnostic Radiology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, 1873 Rama 4 Road, Pathumwan, Bangkok, Thailand

    Thitinan Chulroek

  3. Department of Diagnostic Radiology, Faculty of Medicine, Vajira Hospital, Nawamindradhiraj University, Bangkok, Thailand

    Dearada Wangcharoenrung

  4. Department of Radiology, Prince of Songkla University, Hat Yai, Songkhla, Thailand

    Kamonwon Cattapan

  5. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA

    Alissa J. Mitchell

  6. Department of Urology, Massachusetts General Hospital, Boston, MA, USA

    Alissa J. Mitchell & Elise J. B. De

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  1. Thitinan Chulroek
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Correspondence to Thitinan Chulroek.

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IRB statement

Institutional Review Board (IRB) and Health Insurance Portability and Accountability Act (HIPPA) approval were obtained and requirement for informed consent was waived by our hospital IRB. IRB Number: 2017P002120.

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Chulroek, T., Wangcharoenrung, D., Cattapan, K. et al. Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst?. Abdom Radiol 44, 2852–2863 (2019). https://doi.org/10.1007/s00261-019-02052-w

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