Urethral injuries after pelvic trauma: evaluation with urethrography.

Urethral injury is a common complication of pelvic trauma that, if undiagnosed, may lead to significant long-term morbidity. Segments of the urethra that are near the pubic rami and the puboprostatic ligaments are particularly vulnerable. Although computed tomography is commonly used for the initial imaging evaluation of patients with polytrauma, urethral injury is better assessed and classified by using urethrography. Complete urethral imaging is especially important at presentation because the insertion of a transurethral bladder catheter may exacerbate an existing injury (eg, cause a partial urethral tear to become a complete transection). However, even for radiologists who are familiar with standard technique, urethrography after pelvic trauma may be particularly challenging because the patient is immobile or a surgical fixation device or indwelling urethral catheter is present. Various methods may used to overcome these difficulties and ensure that optimal images are obtained so that a correct diagnosis can be made without additional imaging evaluations. (c) RSNA, 2008.