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CT Voiding Urethrography and Virtual Urethroscopy: Preliminary Study with 16-MDCT

¹ Department of Radiology, Kaohsiung Veterans General Hospital, 386 Da-Chung First Rd., Kaohsiung 813, Taiwan, ROC.
² National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
³ Department of Urology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.

View larger version (116K): [in a new window]   Fig. 1A. —Imaging of urethra with 2D and 3D techniques in 27-year-old man after vehicle accident. Three-dimensional volume-rendered urogram shows comminuted fractures of left ilium bones extending to left acetabulum with displaced bone fragments, and diastasis of bilateral sacroiliac joints and symphysis pubis. Urethra (arrows), urinary bladder, and ureters (arrowheads) are shown well. No urethral interruption or contrast medium extravasation is noted.

View larger version (125K): [in a new window]   Fig. 1B. —Imaging of urethra with 2D and 3D techniques in 27-year-old man after vehicle accident. Two-dimensional curve reformatted sagittal image using maximum intensity projection shows normal segmental anatomy of male urethra. M = membranous urethra, P = prostatic urethra, B = bulbous urethra, Pe = penile urethra.

View larger version (121K): [in a new window]   Fig. 2A. —37-year-old man with straddle injury. Display panel of 3D volume-rendered virtual urethroscopy shows axial, sagittal, and coronal reference images. Verumontanum is viewed at 6-o'clock position (arrow). Fly path of virtual urethroscopy is identified on synchronized multidirectional reference images.

View larger version (68K): [in a new window]   Fig. 2B. —37-year-old man with straddle injury. Vessel-view display panel shows entire urethra with 2D curve multiplanar reformation technique and measurement tools. Focus pointer (arrows) displays as line in vessel navigator. When focus pointer is moved, reference imaging segments are synchronized to position of pointer.

View larger version (133K): [in a new window]   Fig. 2C. —37-year-old man with straddle injury. Maximum transverse diameter and area in axial cross-section of urethra are determined automatically by clicking required position of urethral path.

View larger version (188K): [in a new window]   Fig. 3A. —25-year-old man who presented with hematuria after blunt perineum contusion. Retrograde urethrogram shows contrast medium extravasation (arrow) in bulbous urethra.

View larger version (75K): [in a new window]   Fig. 3B. —25-year-old man who presented with hematuria after blunt perineum contusion. Volume-rendered CT voiding urethrogram obtained with contrast infusion from suprapubic tube shows contrast extravasation and irregular mucosal surface (arrow) in bulbous urethra. Urethrocavernous and urethrovascular reflux (arrowhead) also were noted.

View larger version (108K): [in a new window]   Fig. 3C. —25-year-old man who presented with hematuria after blunt perineum contusion. Conventional cystourethroscopy image reveals bleeding and perforation at 5- to 7-o'clock position of bulbous urethra.

View larger version (117K): [in a new window]   Fig. 3D. —25-year-old man who presented with hematuria after blunt perineum contusion. Virtual urethroscopy image based on surface rendering shows mucosal disruption (arrows) in bulbous urethra.

View larger version (134K): [in a new window]   Fig. 4A. —50-year-old man with urethral bleeding after sexual activity. Retrograde urethrogram shows no finding.

View larger version (45K): [in a new window]   Fig. 4B. —50-year-old man with urethral bleeding after sexual activity. Contrast medium extravasation (arrow) in penile urethra is identified on CT voiding urethrogram, vessel view.

View larger version (123K): [in a new window]   Fig. 5. —18-year-old man with urethral stricture; he sustained urethral injury 1 year earlier in motor vehicle collision. Multiplanar coronal reformatted image (curved along urethra) shows posterior urethral stricture (arrow) and prostatic urethral dilatation (arrowhead).

View larger version (30K): [in a new window]   Fig. 6A. —38-year-old man with history of hypospadia after plastic surgery 30 years earlier. He arranged another surgical correction because of dripping after voiding. CT voiding urethrogram, vessel view, shows ectopic urethral orifice (black asterisk) in middle of penile shaft and diverticulum (arrow) within penile skin coverage (arrowheads). White asterisk is at expected location of meatus.

View larger version (40K): [in a new window]   Fig. 6B. —38-year-old man with history of hypospadia after plastic surgery 30 years earlier. He arranged another surgical correction because of dripping after voiding. Urethral stricture (arrow) developed 5 months after surgical correction.

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