The Role of Magnetic Resonance Imaging in the Diagnosis and Preoperative Assessment of Sequelae of Combat-related Male Urethral Injuries: A Clinical Series
Year: 2026
Type: article
Study design: Case Report
Abstract: Post-traumatic obliterative strictures and distraction defects of the male urethra resulting from combat trauma are frequently associated with concomitant pelvic and perineal injuries, which complicates accurate topographic assessment of the defect and the selection of optimal surgical management. Radiographic techniques (ante- and retrograde urethrography) remain the mainstay of diagnosis, however, they may be limited in evaluating the proximal margin of the defect and the condition of periurethral tissues. The objective: to determine the diagnostic value of magnetic resonance imaging (MRI) in the preoperative assessment of post-traumatic obliterative strictures and distraction defects of the male urethra, and its impact on the choice of treatment strategy. Materials and methods. A clinical case series of five patients treated between November 2024 and May 2025 is presented in the article. In three cases, urethral injury resulted from gunshot pelvic wounds, in two cases – distraction defects were associated with pelvic fractures (due to blast injury and road traffic accident). All patients underwent standard imaging studies and urethral MRI using the Joshi protocol on a 1.5-T magnetic induction scanner with retrograde urethral filling and multiplanar reconstruction. MRI data were reviewed by both a radiologist and a urologist prior to surgical intervention. Results. In all cases, MRI provided accurate assessment of defect length and location, the degree of periurethral fibrosis, and spatial relationships with adjacent structures; the obtained measurements fully correlated with intraoperative findings. MRI findings facilitated individualized surgical decision-making – ranging from anastomotic urethroplasty with additional maneuvers to endoscopic interventions in cases with preserved lumen. At 6-month follow-up, all patients achieved spontaneous voiding without urinary incontinence. Conclusions. Urethral MRI performed according to the Joshi protocol is an informative tool for preoperative planning in complex post-traumatic urethral injuries resulting from combat trauma and may improve the rationale for selecting the optimal surgical strategy.
Source: Health of Man
Language: English
Subfield: Urology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7204550820