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Abstract
Blunt pelvic trauma results in posterior urethral distraction defects (PFUDDs) in 10% of cases, such injury involves the membraneous urethra at the point of departure from the bulbospongiosum, at the prostatomembraneous junction, or at any point between its departure and the apex of the prostate.
Selecting the proper surgical approach for reconstruction in PFUDD and deciding about the surgical approach in such cases raised the need for proper preoperative radiological evaluation. This radiological study should be well informative about the anatomy of PFUDD pathology, highly efficient in diagnosis of associated lesions in complex cases and the relation of the distracted urethral segment to pelvic bone. It also should be reliable for making a proper decision about reconstruction plan and surgical approach.
The length of the defect is important because it guides the type of repair that is likely to be successful, most of these defect are short (1-2cm). Long defects are important to define pre-operatively because more complex surgical procedures are often required. In most of PFUDD, The prostatic apex is districted posterior & slightly to right or left.
When multiple pelvic fractures and associated patient discomfort are present, the oblique position for conventional radiography may not always be possible. CT cysto- urethrography is more convenient because patients are required to adopt only one position and the scanning time is only 6 sec. CT cysto- urethrography is more accurate with computeraided tools for urethral measurement.
Because CT easily depicts the high attenuation produced by contrast material, diluted contrast material is better appreciated on CT images than on conventional VCUG. Missing of lesions obscured by bone structures, contrast media, or instruments can be avoided with use of axial and multiplanar images.
This study showed how beneficial of MCT-VCUG for the urologist to choose the reconstructrion plan and the surgical approach, as with one CT image viewed from 36 different angles as static and dynamic films, this feature allows the urologist to view the PFUDD through several planes and identify precisely its anatomy. Also, studying the relations of the distracted segments to the pelvic bones to determine the surgical approach.