Abstract: PD29-11
Sources of Funding: None

Introduction

MRI is a helpful especially in complex cases of PFUI, which includes long gaps, floating bone chips, rectourethral fistula and bladder neck injury. Conventionally radiologists perform MRI on an empty bladder. Urologists and radiologist assess urethral gap using voiding cystourethrogram (VCUG) and retrograde urethrogram (RGU) studies. The aim of this study was to evaluate the urethral gap via MRI using a new point of technique.

Methods

From 1996 to 2016 1032 cases of PFUI have been seen at our institution with 10%being complex. MRI was routinely acquired for complex PFUI by radiologists using traditional protocol . We formulated a recent new technique where the images were obtained using urine as a natural MRI contrast. Ten consecutive cases of complex PFUI were prospectively evaluated with the new MRI protocol. First, a T2 image acquisition was performed. Urethral gap measurements by 4 radiologists were recorded for each case._x000D_ _x000D_ A second T2 image acquisition was performed with patient lying on the table with a full bladder, SPC clamped, straining to pass urine post administration of Tamsulosin while at the same time a premixed solution of sterile saline and lubricating jelly is instilled in the urethra. The bladder was filled physiologically with patient drinking water prior to the study. Urethral gap assessments were repeated using the same 4 radiologists ._x000D_ _x000D_ Additionally, 4 urologists were shown images from each phase of the study and their visual score was recorded – very satisfactory (4), satisfactory (3), disappointed (2) and extremely disappointed (1)._x000D_

Results

Table 1_x000D_ Figure 1

Conclusions

The described novel technique of MR assessment of urethral gap in pelvic fracture urethral injuries shows promising results and is a true reflection of the actual urethral gap which helps in planning surgical approach. The simple modification of having a full bladder, use of Tamsulosin and straining (dynamic images) helps to mimic a conventional VCUG and RGU along with advantages of MRI.

Funding

None