Magnetic Resonance Imaging (MRI) in pelvic fracture urethral injuries to evaluate urethral gap: A new point of technique
Author(s):
DR PANKAJ JOSHI
,
DR PANKAJ JOSHI
Affiliations:
Dr SUBRAMANIAN IYER
,
Dr SUBRAMANIAN IYER
Affiliations:
DR DEVANG DESAI
,
DR DEVANG DESAI
Affiliations:
DR SANDESH SURANA
,
DR SANDESH SURANA
Affiliations:
DR HAZEM ORABI
,
DR HAZEM ORABI
Affiliations:
PROFESSOR SANJAY KULKARNI
PROFESSOR SANJAY KULKARNI
Affiliations:
BAUS ePoster online library. Iyer S. 06/27/17; 177373; P4-7 Disclosure(s): Nothing to Declare
Mr. Subramanian Iyer
Mr. Subramanian Iyer
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Abstract
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INTRODUCTION:
MRI is helpful in imaging complex cases of PFUI with long gaps, floating bone chips, rectourethral fistula and bladder neck injury. Conventionally radiologists perform MRI on an empty bladder. The aim of this study was to evaluate the urethral gap with MRI using new point of technique.

Methods:
From 1996 to 2016, 1062 cases of PFUI have been seen at our institution with 10% being complex. MRI was routinely acquired by radiologists using traditional protocol involving IV contrast. We formulated a technique using urine as a natural contrast. Ten consecutive complex PFUI patients were prospectively evaluated with the new MRI protocol. First, a T2 image acquisition was performed. Urethral gap measurements by 3 radiologists were recorded.
A second T2 image acquisition was performed with full bladder, SPC clamped and straining to pass urine post administration of Tamsulosin. Simultaneously a solution of sterile saline and lubricating jelly is instilled in the urethra. Urethral gap assessments were repeated using the same radiologists and results recorded.
3 urologists were shown images and their visual score recorded – very satisfactory (4), satisfactory (3), disappointed (2) and extremely disappointed (1).

Conclusion:
Our novel technique of MR assessment of urethral gap in pelvic fracture urethral injuries shows promising results and is a true reflection of the actual urethral gap which helps in planning surgical approach. The simple modification of having a full bladder, use of Tamsulosin and straining (dynamic images) helps to mimic a conventional VCUG and RGU along with advantages of MRI
.

INTRODUCTION:
MRI is helpful in imaging complex cases of PFUI with long gaps, floating bone chips, rectourethral fistula and bladder neck injury. Conventionally radiologists perform MRI on an empty bladder. The aim of this study was to evaluate the urethral gap with MRI using new point of technique.

Methods:
From 1996 to 2016, 1062 cases of PFUI have been seen at our institution with 10% being complex. MRI was routinely acquired by radiologists using traditional protocol involving IV contrast. We formulated a technique using urine as a natural contrast. Ten consecutive complex PFUI patients were prospectively evaluated with the new MRI protocol. First, a T2 image acquisition was performed. Urethral gap measurements by 3 radiologists were recorded.
A second T2 image acquisition was performed with full bladder, SPC clamped and straining to pass urine post administration of Tamsulosin. Simultaneously a solution of sterile saline and lubricating jelly is instilled in the urethra. Urethral gap assessments were repeated using the same radiologists and results recorded.
3 urologists were shown images and their visual score recorded – very satisfactory (4), satisfactory (3), disappointed (2) and extremely disappointed (1).

Conclusion:
Our novel technique of MR assessment of urethral gap in pelvic fracture urethral injuries shows promising results and is a true reflection of the actual urethral gap which helps in planning surgical approach. The simple modification of having a full bladder, use of Tamsulosin and straining (dynamic images) helps to mimic a conventional VCUG and RGU along with advantages of MRI
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