MRI detection of posterior urethral diverticulum following surgical repair of anorectal malformations

To identify and to assess imaging and clinical features of Posterior urethral diverticula (PUD) in a single-centre series and include a brief review of literature. Post operative MRI of 140 children from north India were retrospectively reviewed who underwent surgical repair for anorectal malformation (ARM) along with the Hospital records. Ten cases had MRI features of posterior urethral diverticulum. All of these patients had undergone primary abdominoperineal pull through (APPT) procedure. The lesions ranged between 6mm and 38mm in size. Two of these lesions were missed in the post operative MRI report. Only one of these patients was symptomatic and presented with dribbling of urine and gross bilateral vesicoureteric reflux in which the diverticulum was excised surgically. PUD is an under-recognised entity and can be identified in preclinical stage on MRI. Careful assessment of urethra and periurethral structures should be a mandatory step in MRI evaluation of post repair ARM cases. An observational conservative approach in selected asymptomatic patients can be an effective management strategy.