Answer to the question from page 105

The element of the urinary tract that remains to be examined is the urethra. At fi rst, it was assessed with the use of a convex transducer via the transperineal access (fi g. 1). The registered image indicates a pathology in the region of the urethra, but it is insuffi cient to establish a defi nite diagnosis. Therefore, a linear high-frequency probe was placed at the same site (fi g. 2) which helped to visualize four lesions (fig. 2 presents two of them). Due to their appearance and localization, they suggest diverticula of the urethra. Can the US examination end here? Absolutely not, because if any lesion is visualized in standard ultra-sound, it also needs to be assessed in terms of vasculariza-tion. In this patient, venous fl ow was observed in one of four anechoic lesions (fi g. 3). Further and more extended scanning in this region also revealed several vulvar varicose veins. The case presented above is a typical example of a diagnostic challenge with concomitant dysuria which may be a manifestation of numerous underlying pathologies that not necessarily originate from the urinary tract. The ultra-sound examination of the urethra is not popular among urologists. In the past, this pathology was diagnosed in radiography in the form of voiding cystourethrography, retrograde urethrography and the most effective, but at the same time the most invasive – double-balloon urethrogra-phy. Currently, the arsenal of techniques is enriched with CT, MRI and US examinations. Sonography can be performed via various access sites: transabdominal (poor effectiveness), transvaginal, transrectal and transperineal. The last access mentioned provides accurate information concerning the anatomy and function of the urethra. More data on anatomy may be obtained when an endovaginal three-dimensional probe is used (1) , which would be the best choice in the case discussed in the riddle. It is needed for an accurate localization of diverticula in relation to the ure-thra prior to a planned surgery. Urologists are also interested in information about their number, size and site of their opening to the urethra. This pathology is not rare – it may be expected to occur in 1–6% of women (2). A defi nite diagnosis of a urethral diverticulum requires imaging its neck and fi lling it with contrast which may be urine itself during voiding sonourethrography. Recently, a paper has been published (3) which demonstrates that a diluted second-generation ultrasound contrast agent may be used for …