Objectives: To determine the prevalence of radiologic images suggestive of urethral diverticula (UD) in men with spinal cord injury (SCI) and to study the interobserver diagnostic reproducibility. Methods: Radiological studies (i.e. voiding cystourethrography and retrograde urethrography) performed over 1 year on men with SCI were independently reviewed by 3 researchers (1 urologist and 2 radiologists). Results: The prevalence of UD was found to be between 4.2 and 9.8% of the patients, the higher figure obtained when including also the doubtful images. The kappa index of agreement between the researchers was low (between 0.15 and 0.40). The factors that significantly influenced agreement were localization in the prostatic urethra (p = 0.021), localization in the penile urethra (p = 0.000) and fusiform morphology (p = 0.004). Logistic regression analysis showed that the variables that independently influenced diagnostic agreement were the following: localization in the penile urethra (in favor of agreement) and fusiform morphology (against agreement). Conclusions: Radiologic images suggestive of UD constitute a frequent finding in men with SCI and raise important diagnostic problems.

Keywords:
Male urethra, Diverticulum, Cystourethrography, Spinal cord injury, Interobserver reproducibility, Prevalence
1.
Hosseinzadeh K, Furlan A, Torabi M: Pre- and postoperative evaluation of urethral diverticulum. AJR Am J Roentgenol 2008;190:165-172.
2.
Ramírez Backhaus M, Trassierra Villa M, Broseta Rico E, Gimeno Argente V, Arlandis Guzmán S, Alonso Gorrea M, Jiménez Cruz JF: Divertículos uretrales. Revisión de nuestra casuística y de la literatura. Actas Urol Esp 2007;31:863-871.
3.
Rimon U, Hertz M, Jonas P: Diverticula of the male urethra: a review of 61 cases. Urol Radiol 1992;14:49-55.
4.
Rovner ES: UD: a review and an update. Neurourol Urodyn 2007;26:972-977.
5.
Donnellan SM, Bolton DM: The impact of contemporary bladder management techniques on struvite calculi associated with spinal cord injury. BJU Int 1999;84:280-285.
6.
Secrest CL, Madjar S, Sharma AK, Covington-Nichols C: Urethral reconstruction in spinal cord injury patients. J Urol 2003;170:1217-1221.
7.
Saenz de Cabezón Martí J, Lorente Garín JA, Vallejo Gil C, Raventos Busquets C, Conejero Sugrañés J: Divertículo uretral adquirido en pacientes con lesión medular. Arch Esp Urol 1995;48:797-803.
8.
Paulhac P, Fourcade L, Lesaux N, Alain JL, Colombeau P: Anterior urethral valves and diverticula. BJU Int 2003;92:506-509.
9.
Pavlica P, Barozzi L, Menchi I: Imaging of male urethra. Eur Radiol 2003;13:1583-1596.
10.
Ryu J, Kim B: MR imaging of the male and female urethra. Radiographics 2001;21:1169-1185.
11.
Strasser H, Klima G, Poisel S, Horninger W, Bartsch G: Anatomy and innervation of the rhabdosphincter of the male urethra. Prostate 1996;28:24-31.
12.
Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King BF Jr, Goldman SM: Imaging of urethral disease: a pictorial review. Radiographics 2004;24(suppl 1):S195-S216.
13.
Hardy AG: Complications of the indwelling urethral catheter. Paraplegia 1968;6:5-10.
14.
Virgili G, Andreassi P, Tamburro F, Micali S, Torelli F, Giurioli A, Vespasiani G: I diverticoli uretrali nel paziente mieloleso: studio ecografico. Arch Ital Urol Androl 1994;66 (4 suppl):187-191.
15.
Golji H: Complications of external condom drainage, Paraplegia 1981;19:189-197.
16.
Juma S, Mostafavi M, Joseph A: Sphincterotomy: long-term complications and warning signs. Neurourol Urodyn 1995;14:33-41.
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2013
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