Vol 13 No 02   March-April 2016   2590Vol 13 No 02   March-April 2016   2656

Acute Urinary Retention in a Female Following Bladder Tumor Resection Due To a Stone in a Urethral 
Diverticulum

PICTORIAL

Osama Z Abusanad, Michael S Floyd (Jr),* Altaf Qadir Khattak

A 56 years old female smoker presented with recurrent urinary tract infections but no hematuria. Pelvic exam revealed an indurated area on the anterior vaginal wall. Magnetic resonance imaging (MRI) revealed a sus-
picious area around the urethra which was thought to be tumor extension from a bladder cancer (Figure 1). Rigid 
cystoscopy demonstrated a tight urethra and a bladder tumor. Histology confirmed adenocarcinoma. The patient 
developed acute urinary retention following catheter removal and commenced intermittent catheterization. Due to 
the aggressive histology and concerns over urethral involvement, a repeat MRI (Figure 2) was performed to permit 
local staging with a view to exenteration. This was preferred over a transvaginal scan as resection had confirmed 
a neoplastic process. When compared to the initial MRI a stone was seen, which had initially been suspected to be 
direct tumor extension, but no adenopathy. Repeat cystoscopy showed a large stone in a urethral diverticulum and 
recurrent bladder tumor. The stone was dislodged and treated with laser lithotripsy. The patient was treated with 
pelvic exenteration and adjuvant chemotherapy for a pT4 N2 bladder cancer. Urethral diverticulum stones may 
cause recurrent urinary tract infections in females.(1) Laser lithotripsy and diverticulum repair have been described.
(2) MRI has limitations when assessing female urethral pathology.(3)

REFERENCES
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Neurourol J. 2011; 15:55-7. 
 2.  Susco BM, Perlmutter AE, Zaslau S, Kandzari SJ. Female urethral diverticulum containing a calculus: a 

case report. W V Med J. 2008;104:15-6.
 3.  Chung DE, Purohit RS, Girshman J, Blaivas JG. Urethral diverticula in women: discrepancies between 

magnetic resonance imaging and surgical findings. J Urol. 2010;183:2265-9. 

Department of Urology, Whiston Hospital, St. Helens and Knowsley Teaching Hospitals, NHS Trust, Merseyside, L35 5DR, 
UK.
*Correspondence: Department of Urology, Whiston Hospital, St Helen's and Knowsley Hospital NHS Trust, Merseyside, 
L35 5DR, UK. 
Tel: + 44 151 4261600. Fax: + 44 151 4301405. E-mail: nilbury@gmail.com. 
Received March 2015 & Accepted October 2015

Figure 1. Magnetic resonance imaging (MRI) demonstrating a suspicious 
area around the urethra.

Figure 2. Repeat magnetic resonance imaging (MRI) demonstrating a 
stone when compared to the initial MRI.