Urethra trauma

This chapter discusses drug s used to treat urinary tract infections (UTIs) and certain miscellaneous drag > used to relieve the symptoms associated with an overactive bladder (involuntary contractions of the detrusor or bladder muscle). Structures of the urinary system that may be affected include the bladder (cystitis), prostate gland (prostatitis), the kidney, or the urethra (see Pig. 47-1). These drug s also help control the discomfort associated with irritation of the lower urinary tract mucosa caused by infection, trauma, surgery, and endoscopic procedures. 

Sexual intercourse may precipitate an episode of cystitis due to minor trauma or infection arising from bacteria being pushed along the urethra (so-called honeymoon cystitis ). Post-coital voiding of urine has been suggested as a means of reducing the risk of cystitis but again this is not evidence-based. 

In men, SUI is most commonly the result of prior lower urinary tract surgery or injury, with resulting compromise of the sphincter mechanism within and external to the urethra. Radical prostatectomy for treatment of adenocarcinoma of the prostate is probably the most common setting in which surgical manipulation leads to UI. Overall, SUI in the male is uncommon, and in the absence of prior prostate surgery, severe trauma, or neurologic illness, is extraordinarily rare. Transurethral resection of the prostate for benign prostatic hyperplasia (see Chap. 82) may also lead to SUI in men. 

Special attention should be paid to reduce any psychological trauma in these young children (e.g. catheterization of the urethra) and the environment of the radiology room should be adapted to calm and be user friendly for neonates and young children (e.g. the ambient experience) (Devos and Meradji 2003). 

Posterior urethra can be injured in patients with pelvic traumas. Precise definition of pelvic fracture location may enable prediction of which subjects are at risk for posterior urethral injury (Basta et al. 2007). 

Because of its length, the male urethra is vulnerable to traumatic lesions that may cause acute urinary retention and sudden onset of urethrorrhagia and even late stenosis. Urethral trauma can be divided into external trauma, either contusive or penetrative, and internal or endourethral trauma. Internal traumas usually follow iatrogenic maneuvers. External traumas are frequent events and can occur in the penile urethra as a result of road or work accidents, sporting activities or sex. The urethra can be compressed by subcutaneous or intraspongiosal hematomas and may present complete or incomplete mucosal interruption. 

CT has a limited role in the evaluation of the urethra. Certain urethral abnormalities such as calculi or diverticula may be incidentally discovered at CT performed for other indications. CT is useful in patients with pelvic trauma (Chou et al. 2005) and associated urethral injuries and for staging of urethral carcinoma. CT virtual cystoscopy and voiding urethrography can be indicated in patients with complex urethral strictures and malformations. 

Fig. 6.11. VCU in a 7-year-old boy with history of dys-uria no history of trauma. During micturition, a distended posterior urethra was identified as well as a diverticulum associated with stenosis...

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