Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - a pilot study

Abstract

Objectives 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.

Epidemiology and aetiology of male and female sexual dysfunctions related to pelvic ring injuries: a systematic review

“…Sixty studies were excluded because they did not fulfill inclusion criteria. Finally, 17 studies that met inclusion criteria were included in the review [5,10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (Figure 1). Among them, one had a level of evidence II, four had a level of evidence III, while 11 had a level of evidence IV [27].…”

“…DYS in woman represents painful sexual intercourse [29]. In nine studies, the authors used the International Index of Erectile Function (IIEF) questionnaire for the evaluation of sexual dysfunction [13,16,[20][21][22][24][25][26]. Ad hoc questionnaire, Arizona Sexual Experiences Scale (ASEX) [25], Female Sexual Function Index (FSFI) [25], and Majeed and Hannover questionnaire were also used in other studies [23].…”

“…Only 14 of 17 studies evaluated the association between SD and concomitant genitourinary lesions after a pelvic ring fracture. Among these, 8 studies (47%) [10,13,14,18,20,[22][23][24] reported that genitourinary injuries represent an additional risk factor for the development of SD, both in man and women. However, the correlation seems to be moderate and mostly not statistically significant.…”

Pelvic fracture urethral injury in males—mechanisms of injury, management options and outcomes

“…Arteriogenic ED may occur from fracture-related injury to the main trunk of the internal pudendal artery, to the penile artery as it passes through the perineal membrane, or to the accessory pudendal artery. Venogenic ED is consequent to damage to the corporal bodies resulting in corpora-veno occlusive dysfunction and/or penile venous leakage ( 231 , 284 , 289 , 292 , 293 ).…”

Lower Urinary Tract Injuries: A Guide for the Emergency Radiologist

“…There is limited evidence on the role of magnetic resonance (MR) imaging (MRI) for the assessment of urethral injuries—a recent study by Pandian et al on the use of MR urethrogram for further evaluation of male patients with urethral injuries scheduled for surgery reported that the MRI findings did not alter subsequent surgical management. 35…”