Bladder base impressions due to prostatic hypertrophy are a common urographic finding In older males. A similar appearance may be occasionally seen in females and presents a more difficult diagnostic problem. Sixteen such cases of bladder base defects In females at two Institutions were Identified. The impressions were caused by symphysispubis asymmetry,postoperativechange, urethral diverticulum, levator ani Impression, or â€oe¿ urethral syndrome.―Vaginal fibromyoma, ectopic ureterocele, and intramural bladder neoplasm can also cause this defect, although no such cases were found In this series.Bladder base impressions due to prostatic hypertrophy are a common uro graphic finding in older males. A similar appearance may be occasionally seen in females and this presents a more difficult diagnostic problem. We have reviewed a number of cases of such bladder base defects in females and believe this impression to be caused by any one of several unrelated etiologies.
Materialsand MethodsSixteencasesof bladderbaseimpressionsin femaleshavebeen identifiedduring a 3 year periodat NorthCarolinaMemorialHospitaland Universityof VirginiaMedicalCenter. Retrospectivechart analysescorrelatedclinical historiesand physicalfindings with the radiologic observations.
ResultsProbable explanations for these bladder base defects were found in all 16 patients (table 1). The most common cause was irregularity of the symphysis pubis found in eight multiparous females ( fig. 1). Postoperative changes associ ated with the Marshall-Marchetti procedure for cystocele was the presumed etiology in four patients ( fig. 2). The ‘¿ ‘¿ female urethral syndrome' ‘¿ as first do scribed by Moore [1] and then demonstrated radiographically by Jackson [2] was probably the cause in two patients ( fig. 3). Impressions on the bladder from levator ani muscles were the cause in one patient ( fig. 4) and a urethral diverticulum was present in one case ( fig. 5). However, this patient also had irregularity of the symphysis.
DiscussionVirchow [3] first made reference to the female prostate in 1853 in describing urethral glands in elderly females. Since then, there has been considerable speculation as to whether such an anatomic structure exists. Johnson [4] and Young [5] provided histologic and embryonic support for such an entity. However, it seems unlikely that such a structure ever hypertrophies sufficiently to be visualized on conventional radiography.
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