Many other agents (collagen, ethylene vinyl alcohol, hyaluronic acid, etc.) have been used historically but have been discontinued in United States
Artificial Urinary Sphincter
Limited to treatment of male incontinence
Similar design to 3-piece inflatable penile implant consisting of pump, reservoir, and cuff
Reservoir placed in perivesical soft tissue
Inflatable cuff is placed surrounding bulbar urethra
When inflated, urethra is coapted and continence is maintained
Valve is placed in scrotum
Activation of valve deflates cuff and opens urethra allowing for voiding
IMAGING
Penile Prothesis
Urethral Bulking Agents
Artificial Urinary Sphincter
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Ramanathan S et al: Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters. Abdom Radiol (NY). 45(7):2018-35, 2020
Chulroek T et al: Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst? Abdom Radiol (NY). 44(8):2852-63, 2019
Lakhoo J et al: MRI of the male pelvic floor. Radiographics. 39(7):2003-22, 2019
Sekhar A et al: Imaging of the female urethra. Abdom Radiol (NY). 44(12):3950-61, 2019
Gaines N et al: Radiographic misdiagnoses after periurethral bulking agents. Female Pelvic Med Reconstr Surg. 24(4):312-4, 2018
Khatri G et al: Postoperative imaging after surgical repair for pelvic floor dysfunction. Radiographics. 36(4):1233-56, 2016
Mulcahy JJ: The development of modern penile implants. Sex Med Rev. 4(2):177-89, 2016
Bridges MD et al: Urethral bulking agents: imaging review. AJR Am J Roentgenol. 185(1):257-64, 2005
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Erectile dysfunction (ED)
Artificial urinary sphincter (AUS)
Inflatable penile prosthesis (IPP)
Synonyms
Penile prosthesis
Penile Implant
Implanted mechanical device used to restore or improve erectile function
Peak implant rates were in 1990s prior to introduction of pharmacologic therapy for ED
After dropping precipitously, implant rates have slowly increased to plateau of about 28,000 per year worldwide
Device types
3-piece IPP
Composed of 2 fluid-containing, expandable cylinders placed in corpora, reservoir placed in perivesical space, and pump placed in scrotum
Rear tip extenders are attached to proximal end of cylinders and are placed far posterior in corpora for anchoring and are rigid (do not inflate)
Tubing attaches 3 components and runs through inguinal canal
Inflation and deflation is achieved by activation of scrotal component, sending fluid from reservoir to cylinders and vice-versa
2-piece IPP
Similar to 3-piece but reservoir is eliminated and fluid is stored in proximal tips of cylinders
Semirigid system
Malleable metallic device that is always rigid and can be bent into position to achieve penetration
Urethral Bulking Agents
Injectable material placed in periurethral tissues
Delivered with needle placed transurethral or periurethral
Injected between bladder neck and mid urethra
Generally used in women with stress urinary incontinence
Less risk than more invasive treatments (i.e., mesh) but lower treatment success rates
Can be used in men with incontinence after prostatectomy
Material adds bulk to weak urethral sphincter and goal is to coapt lumen to prevent incontinence during times of ↑ abdominal pressure
Several devices available for use in United States
Many other agents (collagen, ethylene vinyl alcohol, hyaluronic acid, etc.) have been used historically but have been discontinued in United States
Artificial Urinary Sphincter
Limited to treatment of male incontinence
Similar design to 3-piece inflatable penile implant consisting of pump, reservoir, and cuff
Reservoir placed in perivesical soft tissue
Inflatable cuff is placed surrounding bulbar urethra
When inflated, urethra is coapted and continence is maintained
Valve is placed in scrotum
Activation of valve deflates cuff and opens urethra allowing for voiding
IMAGING
Penile Prothesis
Urethral Bulking Agents
Artificial Urinary Sphincter
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
CLINICAL ISSUES
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Ramanathan S et al: Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters. Abdom Radiol (NY). 45(7):2018-35, 2020
Chulroek T et al: Can magnetic resonance imaging differentiate among transurethral bulking agent, urethral diverticulum, and periurethral cyst? Abdom Radiol (NY). 44(8):2852-63, 2019
Lakhoo J et al: MRI of the male pelvic floor. Radiographics. 39(7):2003-22, 2019
Sekhar A et al: Imaging of the female urethra. Abdom Radiol (NY). 44(12):3950-61, 2019
Gaines N et al: Radiographic misdiagnoses after periurethral bulking agents. Female Pelvic Med Reconstr Surg. 24(4):312-4, 2018
Khatri G et al: Postoperative imaging after surgical repair for pelvic floor dysfunction. Radiographics. 36(4):1233-56, 2016
Mulcahy JJ: The development of modern penile implants. Sex Med Rev. 4(2):177-89, 2016
Bridges MD et al: Urethral bulking agents: imaging review. AJR Am J Roentgenol. 185(1):257-64, 2005
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