Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury

Abstract

The management of male pelvic fracture urethral injury remains a urological challenge. Pelvic fracture urethral injury can be associated with sequelae, such as urethral gap, erectile dysfunction and urinary incontinence. Delayed anastomotic urethroplasty, the gold standard treatment for urethral gaps caused by pelvic fracture urethral injuries, is technically demanding, and reconstructive urologists should preoperatively obtain as much detailed anatomical information as possible. A combination of antegrade and retrograde urethrography is the fundamental preoperative evaluation, but it cannot accurately assess the urethral gap length, the degree of lateral prostatic displacement, the anatomical relationship of the urethra with its surrounding structures (such as the rectum and dorsal venous complex) or periurethral problems (such as minor fistulae or cavitation). To make up for these limitations of urethrography, magnetic resonance imaging has emerged as a non-invasive, multiplanar and high-resolution modality for the evaluation of pelvic fracture urethral injury. Magnetic resonance imaging has excellent soft-tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus enabling clinicians to anticipate the required ancillary techniques for delayed anastomotic urethroplasty and to predict functional outcomes, such as erectile function and urinary continence, after delayed anastomotic urethroplasty. This review discusses the role of magnetic resonance imaging in the evaluation of pelvic fracture urethral injury and its impact on patient management.

Clinical observation of male bulbar urethral strictures resulting from straddle injuries associated with falling from heights and riding activities

“…Additionally, it is easier for injuries to involve the corpus cavernosum in these cases leading to surrounding scarring that can affect erectile function or cause pain during erection [12]. The use of ultrasound or magnetic resonance imaging has been suggested by some authors for preoperative assessment of injuries surrounding the urethra [13,14].…”

“…The LUTS were evaluated using the International Prostate Symptom Score (IPSS). The IPSS was categorized as follows: asymptomatic (0), mild symptoms (1-7), moderate symptoms (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), and severe symptoms (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35). The Quality of Life (QoL) score ranged from 0 to 6, with 0 indicating the best.…”

“…EF was assessed using the International Index of Erectile Function (IIEF-5). The EF was classified into different levels: no erectile dysfunction(ED) (22-25), mild ED (17)(18)(19)(20)(21), mild-to-moderate ED (12)(13)(14)(15)(16), moderate ED (8)(9)(10)(11), and severe ED (1-7). EJF was evaluated using the Ejaculatory Domain-Male Sexual Health Inventory Questionnaire (Ej-MSHQ).…”

Magnetic resonance imaging in the diagnosis of urethral stricture.

“…в 2022 г. (включает 8 исследований по стриктурам задней уретры), не охва-тывают весь спектр исследований по данной теме [6,7], актуальным представляется проведение собственного обзора литературы по изучению различных аспектов применения МРТ при стриктуре уретры у мужчин.…”