Abstract
ABSTRACTObjectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)?Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome.Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20).Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.
Highlights
Posterior urethral injury complicates up to 25% of pelvic fractures arising from blunt pelvic trauma [1]
Following Institutional Review Board and Ethics Committee approval, consecutive men presenting with pelvic fracture urethral distraction defect (PFUDD) scheduled for primary urethral reconstruction were recruited in this study
Patients were classified according to the Erectile Function domain of International Index of Erectile function (IIEF-EF) into three groups: normal erectile function (≥25), mild to moderate erectile dysfunction (ED) [7-24] and severe ED (≤6)
Summary
Posterior urethral injury complicates up to 25% of pelvic fractures arising from blunt pelvic trauma [1]. Since majority of patients with traumatic urethral injuries are younger than 40 years, ED is a devastating complication encountered in up to 54% of these individuals [2, 3]. Patients with PFUDD (pelvic fracture urethral distraction defect) are routinely evaluated with combined RGU (retrograde urethrogram) and MCU (micturating cystourethrogram). Their limitations include the 2 dimensional images and the non-visualization of prostatic urethra in some patients. MR urethrogram has been suggested to show structural details of urethra as well as periurethral tissues with 3-dimensional orientation [8]
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