History of prostate cancer. Status post brachytherapy, complicated by prostatitis. Pelvic/penile/rectal pain and spasms. Assess for sacral or pudendal nerve damage. LUMBAR SPINE: The examination is mildly limited by patient motion. There are 5 lumbar-type vertebrae. There is a broad-based levoconvex curvature, apex at L3. There is minimal anterior subluxation of L3 relative to L4 and L4 relative to L5. Sagittal alignment otherwise is notable for straightening which may reflect patient position. Left L5 spondylolysis is better appreciated on CT.There is multilevel degenerative disc disease manifested by desiccation and height loss, more pronounced at the lower 3 levels where it is severe and associated with endplate irregularity and osteophytes as well as facet arthropathy. In addition, there is subjacent marrow edema (degenerative change type I), most pronounced at L5-S1. The marrow is otherwise heterogeneous but there is no suspicious focal marrow lesion in the lumbar spine. The below described multilevel focal degenerative stenosis of the spinal canal is superimposed on mild congenital/developmental narrowing. The the conus medullaris is at the lower L1 level. The conus medullaris has normal shape and signal.T10-T11 (only on sagittal imaging): There is a disc indenting the ventral aspect of thecal sac causing mild canal narrowing. There is incompletely imaged biforaminal stenoses.T11-T12 (only incidental imaging): There is no spinal canal or neural foraminal stenosis.T12-L1: Minimal disc bulge, moderate ligamenta flava thickening and mild facet arthropathy result in minimal, if any, spinal canal stenosis and mild biforaminal stenoses.L1-L2: Moderate, eccentric to the left disc bulge associated with moderate-to-severe ligamenta flava thickening and mild-to-moderate facet arthropathy result in mild-to-moderate spinal canal stenosis and mild-to-moderate right and mild left neural foraminal stenoses. L2-L3: Moderate, eccentric to the right disc bulge associated with mild-to-moderate ligamenta flava thickening and facet arthropathy results in mild central spinal canal stenosis, right subarticular recess stenosis and moderate right and mild left neural foraminal stenosis.L3-L4: The disc uncovering/bulge, subluxation, moderate facet arthropathy and ligamenta flava thickening result in mild-to-moderate central spinal canal stenosis as well as obliteration of the subarticular recesses as well as moderate right and mild-to-moderate left neural foraminal stenoses.L4-L5: The disc and covering/bulge, subluxation and moderate ligamenta flava thickening and facet arthropathy result in mild central spinal canal stenosis right more than left subarticular recess stenosis. There is also moderate-to-severe right and moderate left neural foraminal stenosis.L5-S1: The disc bulge and the associated osteophytes as well as ligamenta flava thickening and facet arthropathy result in mild central spinal canal stenosis, left subarticular recess stenosis as well as moderate-to-severe left and mild right neural foraminal stenoses.There is right hydronephrosis and hydroureter.PELVIS:The examination is markedly limited by patient motion and inadequate coverage of the lumbosacral plexus. The sacroiliac joints are notable for subchondral hypointense signal, probably reflecting degenerative sclerosis. On the left, along the inferior aspect of the iliac side of the joint, there is a T1-hypointense lesion that measures up to 13 mm and shows contrast enhancement. This was present on the prior examination from February 29, 2016. Otherwise, there is no marrow replacing/destructive lesion in the sacrum or included parts of the iliac bones. There is no epidural tumor.There is no presacral soft tissue mass. The ventral sacral foramina are unremarkable. Increased STIR and contrast enhancement in the dependent dorsal soft tissues, which may reflect congestive process. There is no abnormal contrast enhancement in this soft tissues otherwise. The proximal lumbosacral roots are grossly symmetric and show no focal lesion or abnormal signal. However, the more distal parts of the lumbosacral plexus, including the pudendal nerve, are not adequately covered.
1.Multilevel degenerative lumbar spondylosis is most pronounced in the lower 3 levels. Though central spinal canal stenosis is mild, there is multilevel subarticular recess and neural foraminal stenoses as described above. Foraminal stenosis is moderate on the right at L1-L2, L2-L3, L3-L4, and L4-L5 and on the left at L4-L5 and L5-S1. The subarticular stenoses are present on the right at L2-L3, bilaterally at L3-L4, right more than left at L4-L5 and on the left at L5-S1.2.While there is no spinal osseous metastasis and no lumbosacral epidural tumor, the contrast-enhancing left iliac lesion adjacent to the sacroiliac joint corresponds to sclerosis on the previous CT and is nonspecific, with osseous metastasis not excluded. 3.Due to motion degradation and thick slices, the pudendal nerve is not well assessed. No obvious mass or signal abnormality involving the proximal lumbosacral plexus is evident.4.Right hydronephrosis and hydroureter were present on a previous CT scan from May 27, 2016.