Endorectal coil magnetic resonance imaging for diagnosis of urethral and periurethral pathologic findings in women

Objectives. To report our experience with endorectal coil magnetic resonance imaging (ERC-MRI) in the evaluation of female patients with lower urinary tract symptoms (LUTS). We present the results of symptomatic patients who underwent this imaging modality, to better define its use and to try to identify applications relevant to everyday clinical practice. Methods. We reviewed retrospectively 140 consecutive patients who presented with LUTS and underwent ERC-MRI between June 1997 and June 2000. Assessment included history, physical examination, urodynamic studies, and other radiologic evaluations (such as voiding cystourethrogram). Patients were divided into five groups on the basis of the main indication for ordering the MRI. The results in the subgroups of patients who had repeat ERC-MRI and transvaginal urethrolysis were also analyzed. Results. Findings consistent with periurethral fibrosis were detected in 52% of the patients, most frequently in those with symptoms suggestive of, or with urodynamic evidence of, obstruction. Ten percent of the patients were found to have urethral diverticula; in 54% of this group, the diagnosis was made solely by MRI. Repeat ERC-MRI showed either periurethral fibrosis or a urethral diverticulum in most patients (17 of 22). No correlation was observed between the subjective estimate of scar tissue during urethrolysis and the amount determined by the interpretation of the images. Conclusions. Our 3-year experience suggests that ERC-MRI may help better define the diagnosis of urethral and periurethral pathologic features in female patients with LUTS. With improved patient selection, ERC-MRI will likely have a role in evaluating women with symptoms difficult to explain by other diagnostic modalities.