Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters

Abstract

To discuss the imaging appearances of various pathologies affecting adult male urethra and to review the role of imaging in the assessment of artificial urinary sphincters and penile prostheses. Diagnosis of common male urethral diseases heavily depends on two conventional fluoroscopic techniques namely retrograde urethrography and voiding cystourethrography. These are useful in evaluating common urethral diseases like traumatic injury, infections, and strictures. Cross-sectional imaging can be useful in evaluating periurethral pathologies. Artificial urinary sphincters, slings, and periurethral bulking agents are used in the management of urinary incontinence and imaging can be utilized to detect complications in these devices. Cross-sectional imaging especially MRI plays a significant role in evaluating the different types of penile prostheses and their malfunctioning.

Fluoroscopic Evaluation of the Male Urethra in the Setting of Trauma

“…3 The verumontanum, an important anatomic landmark, is a small area of tissue at the midposterior wall of the prostatic urethra, which contains the utricle and the ejaculatory duct orifices. 3 The membranous segment, a relatively thin and short segment, traverses the urogenital diaphragm. The posterior segments can be difficult to distinguish by fluoroscopic imaging; however, a VCUG distends the posterior urethra effectively.…”

“…1,3 The penile urethra encompasses the urethra distal to the suspensory ligaments, and runs through the midline of the corpus spongiosum. 2,3 The periurethral glands (glands of Littre) line the bulbar urethra and the corpus spongiosum, and secrete lubricating mucus throughout the anterior urethra. The distal penile urethra terminates in the fossa navicularis, a mildly widened portion within the glans penis just proximal to the external meatus.…”

Fluoroscopic Evaluation of the Male Urethra in the Setting of Trauma

“…The prostatic urethra contains the internal sphincter, and runs from the bladder neck to the level of the verumontanum. 3 The verumontanum, an important anatomic landmark, is a small area of tissue at the midposterior wall of the prostatic urethra, which contains the utricle and the ejaculatory duct orifices. 3 The membranous segment, a relatively thin and short segment, traverses the urogenital diaphragm.…”

“…The posterior segments can be difficult to distinguish by fluoroscopic imaging; however, a VCUG distends the posterior urethra effectively. 3 The urogenital diaphragm, a historical misnomer, is often used to describe pelvic anatomy despite some dispute. 4 Sometimes referred to as the perineal membrane, the urogenital diaphragm consists of the external urethral sphincter, Cowper glands, and the deep transverse perineal muscle.…”

“…The distal penile urethra terminates in the fossa navicularis, a mildly widened portion within the glans penis just proximal to the external meatus. 3 The distinction between the anterior segments can be visualized on fluoroscopy due to a slight undulation at the dorsal urethra, which delineates the suspensory ligament (Figure 1).…”