title: Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - A pilot study.
abstract: OBJECTIVE
  To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)?
  
  
  METHODS
  In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome.
  
  
  RESULTS
  Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20).
  
  
  CONCLUSIONS
  MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.
authors.affiliation: Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Rajadoss Muthukrishna
authors.initials: RM
authors.lastname: Pandian
authors.affiliation: Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Nirmal Thampi
authors.initials: NT
authors.lastname: John
authors.affiliation: Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Anu
authors.initials: A
authors.lastname: Eapen
authors.affiliation: Department of Biostatistics, Christian Medical College and Hospital, Tamil Nadu, India.
authors.forename: B
authors.initials: B
authors.lastname: Antonisamy
authors.affiliation: Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Antony
authors.initials: A
authors.lastname: Devasia
authors.affiliation: Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Nitin
authors.initials: N
authors.lastname: Kekre
mesh_terms: D000293:Adolescent; D000328:Adult; D007172:Erectile Dysfunction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D010865:Pilot Projects; D057234:Preoperative Period; D011446:Prospective Studies; D011469:Prostatic Diseases / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D015203:Reproducibility of Results; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014521:Urethra / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D014522:Urethral Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D014554:Urination / Q000502:physiology; D055815:Young Adult
keywords: Erectile Dysfunction; Pelvis; Surveys and Questionnaires