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Year : 2020  |  Volume : 1  |  Issue : 1  |  Page : 46-47

Saddle bag urethral diverticulum in an elderly female – 'Female prostate sign'


1 Department of Radiology, AIIMS, Rishikesh, Uttarakhand, India
2 Department of Urology, AIIMS, Rishikesh, Uttarakhand, India

Date of Submission28-May-2020
Date of Decision02-Jun-2020
Date of Acceptance10-Jun-2020
Date of Web Publication20-Jul-2020

Correspondence Address:
Dr. Sonal Saran
Department of Radiology, AIIMS, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/JME.JME_74_20

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How to cite this article:
Saran S, Kumar S, Mittal A. Saddle bag urethral diverticulum in an elderly female – 'Female prostate sign'. J Med Evid 2020;1:46-7

How to cite this URL:
Saran S, Kumar S, Mittal A. Saddle bag urethral diverticulum in an elderly female – 'Female prostate sign'. J Med Evid [serial online] 2020 [cited 2020 Oct 25];1:46-7. Available from: http://www.journaljme.org/text.asp?2020/1/1/46/290144



A 61-year-old female patient presented to the urology outpatient department of a tertiary care institute with chronic and recurrent lower urinary tract symptoms for 6 months. On local examination, a 5 cm × 4 cm tender cystic lesion was palpated through the anterior vaginal wall from distal urethra up to the bladder. On ultrasound examination, a well-defined cystic lesion measuring 4.8 cm × 3.6 cm × 3.6 cm was noted surrounding the urethra and displacing the vagina posteriorly with internal hyperechoic foci casting distal acoustic shadowing suggestive of calcifications [Figure 1]. Contrast-enhanced magnetic resonance imaging of the pelvis showed a well-defined cystic lesion surrounding the urethra and indenting the base of urinary bladder giving the appearance of 'Female prostate sign'. There were multiple internal altered signal intensity contents within the cyst giving it a complex appearance [Figure 2]. Computed tomography of the pelvis showed a hypodense lesion filled with multiple calculi surrounding the urethra [Figure 3]. A clinico-radiological diagnosis of saddle urethral diverticulum was made. The patient was planned for cystoscopy and diverticulectomy under spinal anaesthesia. Urethral diverticulectomy with lateral vaginal wall flap interposition was performed [Figure 4].
Figure 1: Transvaginal ultrasonography images showing; (a) a relatively well defined heteroechoic lesion filled with fine internal echoes along with large internal hyperechoic foci (solid arrow) casting distal acoustic shadowing (open arrow) and, (b) presence of Foley's bulb in its close contact along the right inferior edge of the lesion

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Figure 2: T2 sagittal (a) and Short-TI Inversion Recovery (STIR) axial (b) images of the pelvis show a well-defined hyperintense lesion surrounding the Foley's catheter inserted into the grossly dilated urethra, indenting the base of urinary bladder giving appearance of 'Female prostate sign'. There is presence of dependent hypointense contents within the lesion representing diverticular calculi (arrow)

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Figure 3: Non-contrast axial computed tomography images through the pelvis show a hypodense lesion with areas of coarse calcification within (arrow)

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Figure 4: (a) Cystoscopic image, and (b) Per-operative photograph of the patient (image courtesy: Department of Urology, AIIMS, Rishikesh)

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Female urethral diverticulum is an uncommon pathological entity that manifests with lower urinary tract symptoms. It is more commonly seen in women in their 3rd–6th decade of life. Three Ds (dysuria, post-void dribbling and dyspareunia) describe the classic manifestation of female urethral diverticulum.[1]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgements

Dr. Vikas Kumar Panwar was involved in patient care (pre and post operative).

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King BF Jr., Goldman SM. Imaging of urethral disease: A pictorial review. Radiographics 2004;24 Suppl 1:S195-216.  Back to cited text no. 1
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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