Evaluation of the urethra in males with spinal cord injury

Of 358 antegrade voiding urethrograms obtained in 200 males with spinal cord injury, the urethra was satisfactorily shown by 154 (77%), permitting evaluation of alterations related to cord damage, surgery, or iatrogenic trauma. In 105 cases the neurogenic urethra was normal, demonstrated only minor distension, or had a patulous appearance, in contrast to urinary tract changes such as a markedly neurogenic bladder, vesicoureteral reflux, and bladder calculi. In 49 patients, abnormalities included (a) changes related to surgical alleviation of sphincter dyssynergia; (b) iatrogenic changes such as diverticula strictures, undermining of the external sphincter ("spiral sign"), and intravasation of contrast material; and (c) pressure necrosis of the urethra. Some changes need no special treatment; others, such as pressure necrosis, require early recognition and prompt therapy.