Retrograde urethrography and voiding cystourethrography are the modalities of choice for imaging the urethra. Cross-sectional imaging modalities, including ultrasonography, magnetic resonance (MR) imaging, and computed tomography, are useful for evaluating periurethral structures. Retrograde urethrography is the primary imaging modality for evaluating traumatic injuries and inflammatory and stricture diseases of the male urethra. Sonourethrography plays an important role in the assessment of the thickness and length of bulbar urethral stricture. Although voiding cystourethrography is frequently used to evaluate urethral diverticula in women, MR imaging is highly sensitive in the demonstration of these entities. MR imaging is also accurate in the local staging of urethral tumors.

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High-frequency ultrasonography is the first modality of choice for the evaluation of scrotal pathology. The use of high-frequency ultrasound is increasing, allowing detection and better characterization of many benign intrascrotal lesions that can be treated with non-surgical management or testicular-sparing surgery.This pictorial essay presents gray-scale and color-flow Doppler features of non-neoplastic intratesticular masses. For ease of understanding, the review is organized into three major categories: cystic, vascular, and solid non-neoplastic masses. Table summarizes the key sonographic features, each with recommended management. Sonographic anatomy of the testisThe normal adult testes in each hemi scrotum are symmetric in size and measure approximately 5x3x2 cm. On ultrasound, a normal testis is identified by the presence of homogeneous, medium-level echoes and is contained by a fibrous sheath called the tunica albuginea. The tunica albuginea is identified on ultrasound as a thin echogenic line around the testis and is externally covered by the tunica vaginalis. The tunica vaginalis consists of visceral and parietal layers that are normally separated by a few milliliters (2-3 mL) of fluid. The tunica attaches to the scrotal wall at the posterolateral aspect of the testis. From the posterior aspect of the testis, the tunica albuginea invaginates within the testis to form an incomplete septum, called the mediastinum testis. Sonographically, the mediastinum testis appears as an echogenic band of variable thickness that extends across the testis in the longitudinal axis (Fig. 1). Multiple fibrous septa extend from the mediastinum into the testis, dividing it into 250 to 400 lobules. Spermatogenesis occurs within the seminiferous tubules contained within these lobules. The seminiferous tubules open into dilated spaces called the rete testis within the mediastinum via the tubuli recti. The normal rete testis can be seen on high-frequency US in 18% of patients. (1). The rete testis drains into the epididymis via 10 to 15 efferent ductules.There are four testicular appendages (remnants of the mesonephric and paramesonephric ducts): the appendix testis (hydatid of Morgagni), the appendix epididymis, the vas aberrans, and the paradidymis. The appendix testis and the appendix epididymis are commonly seen on scrotal US. The appendix testis is a small ovoid structure usually at the upper pole of the testis in the groove between the testis and the epididymis, better seen by the presence of fluid around the testis.The testes are supplied by testicular arteries that arise from the abdominal aorta. The testicular arteries enter the spermatic cord at the deep inguinal ring and continue along the posterior surface of the testis, penetrating the tunica albuginea and forming the capsular arteries that course through the tunica vasculosa, which underlies the tunica ABDOMINAL IMAGING PICTORIAL ESSAY Imaging of non-neoplastic intratesticular massesShweta Bhatt, Syed Zafar H. Jafri, Neil Wasserman, Vikram S. Dogra ABSTRACTThe u...

Purpose We present an MRI classification of benign prostatic hyperplasia (BPH) for use as a phenotype biomarker in the study of proposed therapeutic interventions. Methods T2 weighted magnetic resonance images were obtained at 3 Tesla in patients with suspicion of adenocarcinoma. Previous BPH classifications are reviewed, and implications for inclusion of lobar classification in therapeutic research for BPH are discussed. Summary Six patterns of BPH distribution were identified. Illustrations are shown for each classification type.

To review the anatomic basis of prostate boundary selection on T2-weighted magnetic resonance imaging (MRI). To introduce an alternative 3D ellipsoid measuring technique that maximizes precision, report the intra-and inter-observer reliability, and to advocate it's use for research involving multiple observers. We demonstrate prostate boundary anatomy using gross pathology and MRI examples. This provides background for selecting key boundary marks when measuring prostate volume. An alternative ellipsoid volume method is then proposed using these boundaries in an attempt to improve inter-observer precision. An IRB approved retrospective study of 140 patients with elevated serum prostate specific antigen levels and/or abnormal digital rectal examinations was done with T2-weighted MRI applying a new (Biproximate) technique. Measurements were made by 2 examiners, correlated with each other for inter-observer precision and correlated with an expert observer for accuracy. Correlation statistics, linear regression analysis, and tests of means were applied using p ≤ 0.05 as the threshold for significance. Inter-observer correlation (precision) was 0.95 between observers. Correlation between these observers and the expert (accuracy) was 0.94 and 0.97 respectively. Intraobserver correlation for the expert was 0.98. Means for inter-rater reliability and accuracy were all the same (p = 0.001). We conclude that using more precise reproducible landmarks with biproximate technique, precision and accuracy of total prostate volume is found to be demonstrated.

A total of 132 patients with stage A1 adenocarcinoma of the prostate was followed for 5 to 23 years (mean 8.2 years). Of these patients 52 underwent a second staging transurethral resection of the prostate between 1977 and 1986. Progressive disease developed in 3 of the 12 patients (25%) in whom residual foci of well differentiated cancer were detected by the second transurethral resection and who did not undergo further treatment. Of the 38 patients in whom the second transurethral resection did not detect residual cancer 3 (8%) also had progressive disease. From April 1989 to December 1989, 44 patients were re-evaluated by transrectal ultrasonography and ultrasonographically guided biopsies. Of these patients 3 had locally progressive disease. Progressive disease also developed in 4 more patients. Thus, 13 of the 132 patients (10%) had either locally or systemically progressive disease after long-term followup. The interval from diagnosis of stage A1 disease to detection of progression ranged from 6 months to 20 years (mean 7 years). Ten patients underwent definitive treatment for what was believed to be locally progressive disease, 2 underwent palliative therapy and 1 had no therapy due to poor physical condition. Of the 10 patients who underwent definitive therapy 6 are alive without evidence of disease, 2 died of unrelated causes without evidence of disease and 2 are alive with stage D1 disease. These data suggest that patients in whom a second staging transurethral resection of the prostate detects residual cancer have a high probability of progressive disease. Also, negative findings from a second staging transurethral resection may not exclude the possibility of disease progression. Expectant management of stage A1 disease is warranted but regular and long-term followup is mandatory.

A 50-year-old male Vietnam War veteran presented with a 26-year history of traumatic paraplegia. The patient had total left hip disarticulation and bilateral amputations below the knee. Lateral bladder augmentation and cystoplasty had been performed in 1989, but lower urinary tract drainage had been achieved with suprapubic catheterization for the past 10 years. However, the patient had recurrent urinary tract infections. Previous transrectal ultrasonography (US)-guided biopsies of the prostate gland had revealed chronic prostatic inflammation. Unenhanced abdominopelvic computed tomography (CT) was performed, followed by CT cystography.