Female urethral diverticulum involves the herniation of the urethral mucosa into the anterior vaginal wall. These lesions may communicate with the urethra and cause urinary symptoms. Its diagnosis requires clinical and imaging confirmation. We report a case of a 45-year-old woman who presented with dysuria, pollakiuria, post-micturition dribbling, dyspareunia, and recurrent urinary tract infections. Pelvic examination revealed a tender, compressible antrior pelvic mass, expressing purulent discharge upon compression. Pelvic MRI confirmed a diverticular sac communicating with the urethra. Surgical excision achieved complete removal of the diverticulum, followed by multilayer urethral closure. At follow-up, she showed complete symptom resolution. This case of urethral diverticulum with irritative urinary symptoms and dyspareunia demonstrates the diagnostic value of pelvic MRI.

Traditional vaginal cauterization is practiced in some low-resource settings, including Somalia, for gynecological complaints. Unregulated thermal exposure may cause severe tissue destruction. Circumferential full-thickness vaginal necrosis requiring reconstruction is extremely rare. A 70-year-old multiparous Somali woman presented with severe vaginal pain, foul discharge, fever, and urinary retention 14 days after cauterization. Examination revealed stage IV pelvic organ prolapse and circumferential full-thickness vaginal necrosis extending to within 1 cm of the urethral meatus. Laboratory tests showed leukocytosis (12 400/mm3), elevated C-reactive protein (46 mg/L), and creatinine 1.3 mg/dL. Intravenous antibiotics were initiated. Wound culture grew Klebsiella spp. susceptible to gentamicin, and therapy was adjusted. Surgical debridement followed by colpocleisis was performed. Recovery was uneventful. Traditional vaginal cauterization may cause devastating thermal injury requiring radical surgery. Early recognition and multidisciplinary management are essential. Preventive public health measures are urgently needed.

Vulvar cancer is a rare gynecologic malignancy with a higher incidence in postmenopausal women. Squamous cell carcinoma is the most common histologic subtype (>90% of cases). The majority of affected patients are symptomatic and present with vulvar pruritus, bloody discharge, pain, and/or a palpable mass. The disease is staged by using the International Federation of Gynecology and Obstetrics (FIGO) classification system, which was most recently revised in 2021. The characteristic pattern of local vulvar cancer spread involves infiltrative tumor extension to the urethra, anorectum, vagina, and urinary bladder (less commonly). Lymphatic spread is the primary route of metastasis and a critical prognostic factor. The authors review the vulvar anatomy, as well as the pathogenesis, routes of spread, and key imaging findings of vulvar malignancy. In addition, the roles of multiple imaging modalities including lymphoscintigraphy, MRI, fluorine 18-fluorodeoxyglucose PET/CT, and PET/MRI in diagnosing vulvar cancer and acquiring the information needed for accurate staging, treatment planning, determining the prognosis, and assessing treatment response are outlined. ©RSNA, 2026 Supplemental material is available for this article.

The case of a 65-year-old woman with a complication 15 years after mesh repair of vaginal prolapse is presented. The patient presented with chronic pelvic pain, recurrent urinary tract infections (UTIs), foul-smelling vaginal discharge, and urinary frequency/urgency for the previous eight years. Magnetic resonance imaging led to the diagnosis of vaginal mesh erosion and a urethral diverticular calculus secondary to urethral mesh erosion. Transvaginal removal of the mesh erosion was performed with simultaneous exploration of the urethral diverticulum, removal of a urethral stone, and urethral reconstruction using a multi-layer approach. Three months later she was symptom-free and continent. This case adds to the limited literature on urethral diverticulum with calculi secondary to mesh erosion, and highlights the need for long-term follow-up and clinician awareness of this rare, delayed complication.