POSTER SECTIONS Coverpage Learning objectives Background Findings and procedure details Conclusion Personal information and conflict of interest References

ECR 2021 / C-10954

A radiologist’s guide to the role of urethrography in the assessment of urethral diseases in adult males

Congress:

ECR 2021

Poster Number:

C-10954

Type:

Educational Exhibit

Keywords:

Anatomy, Urinary Tract / Bladder, Fluoroscopy, Cystography / Uretrography, Technical aspects, Diverticula, Fistula, Trauma

Authors:

A. L. F. Yasin, O. Aljaziri, A. H. M. Sha'ban, A. Yousaf, F. S. R. Ameerudeen Moulana, M. A. H. Shah; Doha/QA

DOI:

10.26044/ecr2021/C-10954

DOI-Link:

https://dx.doi.org/10.26044/ecr2021/C-10954

Learning objectives

- Recognize the normal anatomy of the male urethra in urethrographic studies. - Review the different techniques used in urethrography. - Discuss the pitfalls in urethrography and how to avoid them. - Identify common and uncommon urethral diseases in adult males and their distinguishing features on urethrography. - Illustrate the role of urethrography in evaluation of post-surgical course and its role in management guidance.

Background

- Urethrography is a radiographic study of the urethra performed by injecting iodine-based contrast media into the urethra. - Retrograde urethrography and voiding cystourethrography are the modalities of choice for imaging the anterior and posterior parts of the urethra respectively. - Relative contraindications include urinary tract infection and allergy to contrast media. - We will present selected cases collected from our institution data system that will demonstrate a variety of urethral diseases in adult males with focus on conventional urethrography.

Findings and procedure details

Male Urethra Anatomy (Fig. 1) The male urethra is divided into two parts: Anterior part which consists of the penile and bulbar urethrae. Posterior part which consists of the membranous and prostatic urethrae. URETHROGRAPHY Technqiues 2.1 Retrograde urethrography: Urethrography is performed by using either Foley’s catheter or Knutson penile clamp. 2.1.1 Foley’s catheter technique (Fig. 4): Explain all the procedure steps to the patient and reassure him about the discomfort that he might experience. Clean the penis and the surrounding area with iodine and then...

Conclusion

- Despite the advances in both radiology and urology, urethrography remains an essential modality for assessment of the urethra as it is rapid, inexpensive, minimally invasive and able to accurately demonstrate a range of urethral abnormalities. - Urethrography plays an important role in assessing the post-operative urethra and guiding post-surgical management. - Ascending and descending urethrography complement each other in the diagnoses of anterior and posterior urethral pathologies.

Personal information and conflict of interest

A. L. F. Yasin: Nothing to disclose O. Aljaziri: Nothing to disclose A. H. M. Sha'ban: Nothing to disclose A. Yousaf: Nothing to disclose F. S. R. Ameerudeen Moulana: Nothing to disclose M. A. H. Shah: Nothing to disclose

References

Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King BF, Jr., Goldman SM. Imaging of urethral disease: a pictorial review. Radiographics 2004; 24 Suppl 1:S195-216. Urethrography for Assessment of the Adult Male Urethra:RadioGraphicsFundamentals | Online Presentation Jennifer C. Flanagan, RichardBatz, Shaun M.Nordeck, Gary E.Lemack, Cecelia BrewingtonRadioGraphicsVolume 38, Issue 3May 1 2018 McCallum RW. The adult male urethra: normal anatomy, pathology, and method of urethrography.RadiolClinNorth Am 1979; 17:227-244. Pavlica P, Menchi I, Barozzi L. New imaging of the anterior male urethra. Abdom Imaging 2003; 28:180-186. Amis...

Fig 1: Male urethral anatomy on Ascending (a) and Descending (b) phases of the...

Fig 2: Knutson Clamp. The 2 curvilinear clamps (arrows) fix the device to the penis....

Fig 3: Pericatheter urethrogram. The patient has an indwelling catheter (solid arrows)...

Fig 4: Ascending urethrogram (a) shows an apparent stricture in the bulbous urethra...

Fig 5: Ascending urethrogram shows two strictures of the bulbar urethra (solid arrows,...

Fig 6: Ascending urethrogram (a) shows smooth contained filling of the anterior...

Fig 7: Ascending urethrogram shows bulbar urethral stricture (dotted arrow) and...

Fig 8: Descending urethrogram shows contrast reflux into prostatic ducts (arrows).

Fig 9: Ascending urethrogram shows tubular like contrast filling along the bulbar...

Fig 10: Ascending urethrogram shows multiple small linear foci of contrast alongside...

Fig 11: Two patients with urethral injury and hematuria Ascending urethrograms in the...

$Fig 12: Road traffic accident with multiple pelvic fractures had urine retention. Fluoroscopic urethrogram study done through a Foley’s catheter in the urethra (dotted arrow) and a Suprapubic catheter into the bladder (dashed arrow) demonstrates complete transection at the level of the membranous urethra (solid arrow)$

Fig 12: Road traffic accident with multiple pelvic fractures had urine...

Fig 13: History of fall from height with urethral bleeding. Presented with obstructive...

Fig 14: Post urethroplasy Ascending urethrogram demonstrates contrast extravasation...

Fig 15: 68 year-old male with Prostatic Adenocarcinoma post Prostatectomy AP (image a)...

Fig 16: 53 year-old male with suprapubic pain and dysuria. Ascending urethrogram shows...

Fig 17: A 49 years old patient presented with voiding difficulties. The ascending...

Fig 18: 61 year-old male with weak stream and history of prostatic hyper...

Fig 19: Voiding urethrogram demonstrates a contrast-filled outpouching from the ...

Fig 20: Ascending urethrogram shows a sac-like structure at the floor of the bulbar...

Fig 21: Ascending (a) urethrogram shows an oblong contrast-filled outpouch (arrow) in...

Fig 22: A 31 years old patient presented with weak urine stream. Ascending urethrogram...

Fig 23: A 67 years old patient with voiding difficulties and recurrent urinary tract...

Fig 24: 82 years old patient complains of dysuria. Two radiopaque opacities noted in...

$Fig 25: 25 year-old male patient with suprapubic catheter due to urine retention after motor vehicle accident with perineal trauma and pelvic fracture Ascending urethrogram (a) shows tapering with complete cut off at the bulbar urethra proximally (arrowhead) with no contrast flow beyond that point or into the urinary bladder. The descending urethrogram performed through the suprapubic catheter (b) shows dilatation of the prostatic urethra (dashed arrow) and significant opacification of the rectum due urethro-rectal fistula of the membranous urethra (arrow).$

Fig 25: 25 year-old male patient with suprapubic catheter due to urine retention after...

Fig 26: Ascending urethrogram shows contrast being injected using Knutson clamp, with...

Fig 27: A 35 years old patient complained of weak urine stream and post void dribbling....

Fig 28: Post-operative radical prostatectomy micturition cystourethrogram shows...

Fig 29: A 54 years old man presented with voiding difficulty. Ascending (a) and...

Fig 30: Ascending urethrogram shows multiple beaded narrowing of the bulbar urethra...