Preliminary Diagnosis: Urethritis
I. What imaging technique is first-line for this diagnosis?
No specific imaging is required for uncomplicated urethritis. However, imaging may be warranted in those with complicated urethritis. The first line imaging modality is ultrasound of the urinary bladder and limited visualized urethra.
II. Describe the advantages and disadvantages of this technique for diagnosing urethritis.
Advantages
- Highly portable and relatively inexpensive imaging modality.
- Does not expose patients to ionizing radiation.
- Limited in sensitivity and specificity in diagnosing urethritis.
Disadvantages
- Offers limited evaluation of the surrounding soft tissues, osseous structures, and vasculature.
- Urethritis is a clinical and laboratory diagnosis.
III. What are the contraindications for the first-line imaging technique?
No specific contraindications to ultrasound exist.
IV. What alternative imaging techniques are available?
- Retrograde urethrography.
- CT imaging with IV contrast.
- MR imaging with IV contrast.
V. Describe the advantages and disadvantages of the alternative techniques for diagnosing urethritis.
Retrograde urethrography
Advantages
- Offers exquisite evaluation for any mucosal or endoluminal abnormality of the urethra.
Disadvantages
- Exposes patients to ionizing radiation.
- Invasive procedure and exposes patients to the morbidity of an invasive procedure.
- Highly operator dependent.
- Offers limited evaluation of the surrounding soft tissues.
CT imaging with IV contrast
Advantages
- Offers exquisite visualization of the surrounding soft tissues, vasculture, and osseous structures.
- Better evaluates for any secondary complications than other imaging modalities.
Disadvantages
- Exposes patients to ionizing radiation.
- Offers limited evaluation of the mucosa of the urethra and GU structures.
MR imaging with IV contrast
Advantages
- Does not expose patients to ionizing radiation.
- Offers exquisite visualization of the surrounding soft tissues.
Disadvantages
- Expensive.
- Time consuming.
- Offers limited evaluation of the surrounding osseous structures.
- May be subject to motion and susceptibility weighted artifact, degrading image quality.
VI. What are the contraindications for the alternative imaging techniques?
Retrograde urethrography
- No specific contraindications to retrograde urethrography exist.
CT imaging with IV contrast
- May be contraindicated in pregnant patients.
- May be contraindicated in patients with renal failure or contrast allergy.
MR imaging with IV contrast
- May be contraindicated in patients with non-MR compatible hardware.
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