4. Genitourinary (Urethra)

Question 1

Normal anatomy (male) (4)

Answer 1

Most commonly seen on RUG.
Prostatic urethra, Veru-montanum (small outpouching distal to prostate) and membranous urethra will not fill on retrograde study.
Bulbar urethra is site of straddle injury.
Penile urethra is most distal part.

Question 2

Urethral injury grading (5)

Answer 2

Type 1: Stretched
- Periurethral haematoma present, not well seen on RUG
Type 2: Rupture above urogenital diaphragm
- Extraperitoneal contrast is present.
Type 3: Rupture below urogenital diaphragm
- Extraperitoneal and perineal contrast is present
Type 4: Injury involved bladder extending to urethra
Type 5: Injury to the anterior urethra

Question 3

Urethral strictures (4)

Answer 3

Straddle injury
- Most common external cause of traumatic stricture
- Compression of urethra (usually bulbous) against inferior edge of pubic symphysys.
- Commonly bicycle crossbar injury. Short segment stricture
Gonococcal urethral stricture
- Long segment, irregular stricture of bulbous urethra (usually distal bulbous)

Question 4

Pancreatic transplant (2)

Answer 4

Known to cause urethral injury if drainage is to the bladder (old way).
Extravasation from urethral injury occurs in about 5% of cases, due to pancreatic enzymes damaging the urethra.

Question 5

Condyloma acuminata (2)

Answer 5

Multiple small filling defects seen on RUG
Instrumentation/RUG not recommended though due to possibility of retrograde seeding.

Question 6

Urethrorectal fistula (1)

Answer 6

Can occur post radiotherapy, classically with brachytherapy (1%).

Question 7

Urethral diverticulum (1)

Answer 7

Usually due to long term foley catheter.

Question 8

Urethral cancer (3)

Answer 8

Rare. 80% are squamous cell.
Exception is transitional cell cancer is commonest in prostatic urethra.
Cancer in a urethral diverticulum is usually adenocarcinoma.

Question 9

Female urethral diverticulum (5)

Answer 9

Urethral diverticula more common in females. Due to repeated infection of periurethral glands.
Classic Hx of repeated UTIs.
Often coexists with stress incontinence (60%) and UTI.
“Saddle bag” configuration, how you tell it from the urethra.
Stones can develop in them.
Increased risk of cancer, usually adenocarcinoma, due to chronic irritation.