Na. Armenakas et al., POSTTRAUMATIC IMPOTENCE - MAGNETIC-RESONANCE-IMAGING AND DUPLEX ULTRASOUND IN DIAGNOSIS AND MANAGEMENT, The Journal of urology, 149(5), 1993, pp. 1272-1275
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.