POSTTRAUMATIC IMPOTENCE - MAGNETIC-RESONANCE-IMAGING AND DUPLEX ULTRASOUND IN DIAGNOSIS AND MANAGEMENT

In 15 patients, impotent as a result of prostatomembranous urethral di sruption consequent to pelvic crush injuries, magnetic resonance imagi ng (MRI) and duplex ultrasound were used to establish anatomical and p athophysiological criteria for accurate diagnosis and appropriate mana gement. All patients were initially treated by suprapubic cystostomy d iversion for at least 3 months, after which urethral reconstruction wa s performed. All men were potent before the pelvic trauma, with loss o f sexual function immediately thereafter. Preoperative MRI demonstrate d prostatic displacement in 13 cases (86.7%) and cavernous injury in 1 2 (80%). Duplex ultrasound revealed the cause of erectile failure as v asculogenic in 12 patients (80%) and neurogenic in 3 (20%). Treatment of impotence was deferred for at least 18 months after injury. Of the neurogenic group 2 patients were started on intracavernous injection t herapy and 1 refused treatment. Of the vasculogenic group 3 patients u nderwent successful revascularization, 2 are on injection therapy and 1 had a penile prosthesis inserted. The detailed anatomical informatio n obtainable with pelvic MRI and the functional data provided by duple x ultrasonography enabled us to identify the individual organic compon ents of posttraumatic impotence and to select effective cause-specific therapy.