Ascending Urethrogram and Sonourethrogram in Evaluation of Male Anterior Urethra

Dola, V; Konduru, Siva; Ameeral, Anthony; Maharaj, Priya S.; Sa, Bidyadhar; Rao, Ramesh T.; Rao, Seema

doi:10.9734/jammr/2017/33734

Cited by 1 publication

(1 citation statement)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The diagnosis, position, and severity of the stricture in SSA is, therefore, often made on the basis of the patients age, symptoms prior to developing acute retention or from imaging in the form of a cystoscopy or RUG [54]. Voiding cystourethrography (VCUG) [41] and urethral ultrasonography (sono‐urethrogram [SUG]) [55,56] are sometimes undertaken, with SUG being suggested as a better option in LMICs as it is able to show peri‐urethral soft tissues scarring, fibrosis and para‐urethral collections [55]. However, this proposal assumes that the patient can afford imaging [4], the expertise to carry this out is readily available and the investigation provides the diagnostic information of a quality to accurately plan a patient's operative management.…”

Section: Introductionmentioning

confidence: 99%

Male urethral stricture disease: why management guidelines are challenging in low‐income countries

et al. 2022

View full text Add to dashboard Cite

Urethral stricture disease (USD) is one of the commonest urological pathologies in adult men in low-or low-middleincome countries, providing a significant work burden for the small number of specialist surgeons who are able to provide appropriate treatment. The underlying causes of anterior urethral stricture relate to urethral fibrosis from sexually transmitted infection, with posterior urethral disruption secondary to pelvic trauma being an equally common cause of USD in many countries in sub-Saharan Africa. Anterior urethral strictures are often long, and multifocal, and bulboprostatic disruptions are usually due to relatively low-velocity pelvic trauma. The management options available in resourcepoor settings are often severely limited by the individual's ability to pay for care, the availability of a specialist surgeon and, importantly, a shortage of functioning endoscopic equipment for less-invasive treatments. Consequently, reconstructive surgery is often regarded by the patient, and surgeon, as the most cost-effective and, therefore, primary means of treating a urethral stricture once urethral dilatation has failed. Regional anaesthetic techniques have limited the adoption of free-graft augmentation as an alternative to pedicled flaps of locally available skin for reconstruction, whilst an inability to provide tension-free bulbo-prostatic anastomoses has negatively impacted the outcome from the treatment of pelvic fracture disruption injuries in much of sub-Saharan Africa. However, Urolink has found that local surgeons can be taught sustainable skills required for successful complex urethroplasty when supported by longitudinal mentorship in the management of difficult clinical issues. Evidence-based practice is known to improve the standard of care in specific conditions in high-income countries, including the management of male USD. However, guidelines developed in highincome countries are not necessarily appropriate for stricture management in less well-resourced healthcare environments but could be adapted to help improve the delivery of stricture care for men in low-or low-middle income countries.

show abstract