Prospective study of role of mri in pelvic fracture urethral injuries

Introduction: MRI is accurate in demonstrating the distraction defect length and displacement & dislocation of the prostate apex in Pelvic fracture urethral injuries. The soft tissue details by MRI determine the avulsion of the corpus cavernosa which can indicate these patients will develop permanent impotence. The purpose of our study was to evaluate the role of MRI in the management of post traumatic posterior urethral distraction defects.
Materials and methods: The study conducted from December 2017 to February 2020 at Government kilapauk medical college Hospital and Government Royapettah Hospital, Chennai. Thirty eight patients (mean age 24 years; range, 16-42 years) with posttraumatic posterior urethral defect underwent MR imaging before planned definitive surgery. These patients were evaluated using conventional RGU combined with VCUG prior to MR imaging. The interval between the original trauma and the MR imaging, varied from 3 to 8 months (mean, 4.7 months).
Results and Observations: On the basis of the MRI findings, when the distraction defect is 1 to 2.5 cm, primary anastomotic urethroplasty was performed though a perineal approach. The patients who had a long distraction defect 2.5 to 5 cms on MR images underwent progressive perineal anastomotic urethroplasty. In 4 cases the defect was more than 5cms with presence of extensive scar tissue around the prostatic apex, we did urethroplasty through transpubic approach. The surgical findings were correlated with MRI findings. The MRI findings changed the surgical procedure in 12 out of the 38 patients; the surgical procedure which was planned on the basis of the finding from combined RGU / MCUG.
Conclusions: MR urethrography could accurately measure the stricture length in T2 sagittal, coronal views of reconstruction. It also judges the extent of spongiofibrosis, prostatic apex dislocation, which will aid the surgeon to perform appropriate surgical procedure.