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Invited Commentary • Authors' Response

Department of Radiology, University of Alabama at Birmingham, Birmingham, Alabama

View larger version (148K): [in a new window]   Figure a.  Urethral injury in a 24-year-old man who was injured in a motor vehicle collision 2 weeks earlier. He was transferred from another institution after stabilization of pelvic fractures. Since no studies of the lower urinary tract had been performed, CT cystography was requested. (a) CT cystogram shows poor distention of the bladder despite administration of 300 mL of dilute contrast material. The balloon of the Foley catheter is not seen in the bladder. (b) CT cystogram obtained caudad to a shows extensive extravasation. (c) CT cystogram obtained slightly caudad to b shows the balloon of the Foley catheter in a disrupted posterior urethra. The extravasation extended more caudally, a finding indicative of a type III urethral disruption. (d) RUG image obtained after realignment and repair of the urethra shows abnormal widening of the posterior urethra. The patient has nighttime incontinence.

View larger version (148K): [in a new window]   Figure b.  Urethral injury in a 24-year-old man who was injured in a motor vehicle collision 2 weeks earlier. He was transferred from another institution after stabilization of pelvic fractures. Since no studies of the lower urinary tract had been performed, CT cystography was requested. (a) CT cystogram shows poor distention of the bladder despite administration of 300 mL of dilute contrast material. The balloon of the Foley catheter is not seen in the bladder. (b) CT cystogram obtained caudad to a shows extensive extravasation. (c) CT cystogram obtained slightly caudad to b shows the balloon of the Foley catheter in a disrupted posterior urethra. The extravasation extended more caudally, a finding indicative of a type III urethral disruption. (d) RUG image obtained after realignment and repair of the urethra shows abnormal widening of the posterior urethra. The patient has nighttime incontinence.

View larger version (142K): [in a new window]   Figure c.  Urethral injury in a 24-year-old man who was injured in a motor vehicle collision 2 weeks earlier. He was transferred from another institution after stabilization of pelvic fractures. Since no studies of the lower urinary tract had been performed, CT cystography was requested. (a) CT cystogram shows poor distention of the bladder despite administration of 300 mL of dilute contrast material. The balloon of the Foley catheter is not seen in the bladder. (b) CT cystogram obtained caudad to a shows extensive extravasation. (c) CT cystogram obtained slightly caudad to b shows the balloon of the Foley catheter in a disrupted posterior urethra. The extravasation extended more caudally, a finding indicative of a type III urethral disruption. (d) RUG image obtained after realignment and repair of the urethra shows abnormal widening of the posterior urethra. The patient has nighttime incontinence.

View larger version (121K): [in a new window]   Figure d.  Urethral injury in a 24-year-old man who was injured in a motor vehicle collision 2 weeks earlier. He was transferred from another institution after stabilization of pelvic fractures. Since no studies of the lower urinary tract had been performed, CT cystography was requested. (a) CT cystogram shows poor distention of the bladder despite administration of 300 mL of dilute contrast material. The balloon of the Foley catheter is not seen in the bladder. (b) CT cystogram obtained caudad to a shows extensive extravasation. (c) CT cystogram obtained slightly caudad to b shows the balloon of the Foley catheter in a disrupted posterior urethra. The extravasation extended more caudally, a finding indicative of a type III urethral disruption. (d) RUG image obtained after realignment and repair of the urethra shows abnormal widening of the posterior urethra. The patient has nighttime incontinence.