The images demonstrate high density clustered foci within the central lower pelvis. A few further foci noted in isolation along the pelvic sidewall. These appearances are too low central to reflect typical ureteral calculi and too inferior to reflect typical prostatic or seminal vesicle calcifications. The bladder outlines can be identified full of urine and the high density foci are noted to be below this, suggesting these are not bladder calculi. Indeed the density of these abnormalities far exceeds that of bone suggesting that these are metallic or other similar high density. The anatomic location is inferred from the abdominal radiograph but can be further delineated from the additional CT images provided. These demonstrate the presence of high density material below the bladder, surrounding the bladder neck.
These appearances are due to periurethral injection of bulking agents in this case Duraspeheres. These agents are used to tackle stress urinary incontinence in female patients. In this instance the abnormality is due to a pyrolytic coated beads which stimulate collagen formation and improved urinary continence. The additional occasional sidewall high density focus is due to vascular extravasatiion which should be avoided. Bulking materials previously used included autologous fat. However, this has resulted in anecdotal fatal lipid pulmonary embolism and is no longer advised. Injections are targeted into the submucosal tissues of the urethra and bladder neck under anaesthesia.