Saddlebag Periurethral Diverticulum: A Case Report with Interesting MRI Pictorial Review Images

Abstract

Female urethral diverticulum (UD) is a rare condition with atypical imaging findings and is increasingly being diagnosed due to advances in imaging. We report a unique case of saddlebag periurethral diverticulum in a 30-year-old female and highlight its clinical presentation, diagnostic challenges, and management. The patient presented with lower urinary tract symptoms and a painful perineal swelling during micturition. The initial flexible cystoscopy revealed no abnormalities. However, subsequent magnetic resonance imaging (MRI) using a phased-array coil identified a 3.8 cm x 3.1 cm multiseptated, multicystic periurethral lesion with a saddlebag configuration encircling the urethra. The lesion displaced the adjacent structures, including the bladder base and vaginal lumen. Following a urinary tract infection (UTI), the patient was treated with dual antibiotics, leading to symptom improvement and reduced swelling. Despite being offered surgical intervention, she opted for conservative management with no symptom recurrence during follow-up. This case underscores the importance of MRI in diagnosing UD and highlights conservative management as a viable option for selected cases.