Evaluation of the urethra in males with spinal cord injury.

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Abstract
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 markedly neurogenic bladder, vesicoureteral reflux and bladder calculi. In 49 patients, abnormalities included: changes related to surgical alleviation of sphincter dyssynergia; iatrogenic changes such as diverticula, strictures, undermining of the external sphincter (spiral sign) and intravasation of contrast material; and pressure necrosis of the urethra. Some changes need no special treatment. Others, such as pressure necrosis, require early recognition and prompt therapy.