Urethra sonourethrography

Fig. 19.10. Mucosal cyst of the penile urethra. Sonourethrography with sagittal scan. The cyst ( ) is anechoic with regular margin and protrudes into the urethral lumen distended with saline solution...

Fig. 19.12. Infiltrating transitional cell carcinoma of the bulbous urethra. Sonourethrography in sagittal scan. The sonogram shows the lesion protruding in the urethral lumen (arrowheads) with secondary stenosis. The surrounding spongiosa is involved (curved arrows)...

Fig. 19.3a,b. Sonourethrography. Normal appearance of the urethra in sagittal (a) and transversal (b) scans. The urethra distended hy the saline solution appears as an anechoic tubular structure well depicted with linear array transducer using direct skin contact on the ventral surface of the penis and with trans-scrotal and perineal scanning for bulbar urethra... 

Stenoses due to pelvic fracturing, on the other hand, affect almost exclusively the membranous urethra. They can be easily investigated with retrograde urethrography and voiding cystourethrography, but are difficult to explore with sonourethrography. 

Fig. 19.7. Distal urethral stenosis studied with sonourethrography. Long stenosis of the bulbo-perineal urethra. The mucosa is hyperechoic with strong spots due to fibrotic strictures. The corpus spongiosum is thinned and hyperechoic due to chronic inflammation...

Fig. 19.9. Urethral stone studied with sonourethrography. Longitudinal scan of the urethra after fluid distension with saline solution reveals the stone (curved arrow) producing occlusion of the urethral lumen...

Paraurethral cysts of non-traumatic origin are very rare with only a few cases described in the literature (Hakenberg et al. 2000 Bujons et al. 2006). They are usually secondary to submucosal gland distension and appear at ultrasound as lesions with typical anechoic appearance (Fig. 19.10) that adject in the distended urethral lumen. Sonourethrography is indicated to locate the lesion and to assess the relationships with the urethra. 

These lesions have been described in Chapter 19. In brief, paraurethral cysts are usually secondary to submucosal gland distension and appear at ultrasound with a typical anechoic appearance. Syringocele presents at sonourethrography as a tubular image at the bulbous urethra, parallel to the urethral canal, with a double tube appearance. 

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