MRI in patients with urethral stricture: a systematic review

Abstract

U rethral stricture is one of the common male urological disorders with an increasing incidence. Patients may be asymptomatic or present with decreased urine flow, increased pressure required for urinating, a feeling of incomplete urination, urinating in a drop by drop manner and urinary retention. Moreover, ejaculation disorders, often underestimated by physicians, may be encountered, significantly influencing patients' quality of life (1).Stricture might be caused by inflammatory, traumatic, ischemic, congenital or iatrogenic factors resulting in formation of scar tissue along the tract and reducing the caliber of the urethra (2). Disease is associated with high recurrence rate. Mechanisms underlying traumatic strictures include straddle injury, pelvic fracture-related urethral injury and iatrogenic injury secondary to instrumentation also in reference to worldwide increase in endoscopical transurethral treatment methods in the last decades (3).Given that the number of patients suffering from urethral stricture disease is increasing, there is a need for improvement of diagnostic methods determining the choice of the optimal treatment method. Despite numerous surgical methods for treatment of this disease, it is still associated with high recurrence rates.Process of stricture formation is usually associated with scarring within corpus spongiosum and is known as spongiofibrosis. Histological and immunohistochemical studies showed significant changes within the structure of the strictured part of urethral wall in the microscopic images. In contrast to normal urethra wall, the epithelial layer at the site of a stricture is much thicker. Collagen and bundles of elastin are densely packed around the strictured urethra (4). Thus, the most effective method of treatment for patients with urethral stricture with extensive spongiofibrosis is excision of the whole stricture followed by an end-to-end anastomosis of the two healthy ends (5). Therefore, more and more radiologists and urologists require information on the presence of spongiofibrosis and periurethral pathologies for the correct choice of treatment method. Methods of urethral stricture evaluation UrethroscopyDespite the fact that urethroplasty has a much higher long-term success rate and better outcomes in terms of recurrence rate than dilatations and urethrotomies, minimally invasi-ABSTRACT Magnetic resonance imaging (MRI) is gaining acceptance as a diagnostic tool in urethral stricture disease. Numerous publications emphasize on the advantages of MRI including its ability to determine periurethral spongiofibrosis, thus overcoming the main limitation of retrograde urethrography (RUG). It is also becoming an alternative for sonourethrography (SUG), which is a highly subjective examination. Magnetic resonance urethrography (MRU) has become an increasingly appreciated tool for diagnosing patients with urethral stricture disease. Obtained data provides radiologists and urethral reconstructive surgeons with additional information regarding anatomical relationships a...

Mesh Graft Urethroplasty—Still a Safe and Promising Technique in Mostly Unpromising Complex Urethral Strictures

“…Numerous publications had been focusing on MRU in recent years. MRU provides good soft tissue contrast for determining the degree and extent of spongiofibrosis [ 19 ]. The objectiveness of the procedure, absence of radiation exposure and provision of additional information on the surrounding organs and tissues after pelvic trauma are among its strengths [ 20 ].…”

Role of magnetic resonance imaging in the management of male pelvic fracture urethral injury

“…The greatest advantage of MRI over conventional urethrography is its ability to evaluate periurethral anatomy without exposure to radiation 13 . It is particularly powerful in the evaluation of PFUI patients whose normal pelvic anatomy has been disrupted by pelvic trauma.…”

“…To make up for the limitations of urethrography, MRI has emerged as a non‐invasive, multiplanar and high‐resolution modality for the evaluation of PFUI 11,15–21 . MRI has excellent soft‐tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus providing more information than conventional methods 8,13 . The present review discusses the current role of MRI in the evaluation of PFUI and its impact on PFUI management.…”

“…11,15-21 MRI has excellent soft-tissue contrast, and can clearly show the urethra and periurethral tissues without the effects of radiation, thus providing more information than conventional methods. 8,13 The present review discusses the current role of MRI in the evaluation of PFUI and its impact on PFUI management.…”

“…Second, the proximal end of the displaced urethra can be shifted in the horizontal and vertical directions, and urethrography cannot accurately determine the degree of displacement three‐dimensionally 11 . Third, the anatomical relationship between the urethra and its surrounding structures (such as the rectum and dorsal venous complex) or periurethral problems (such as minor fistulae or cavitation) cannot be well detected by urethrography 8,12,13 . In addition, contrast injection into the urethra can be painful, and might lead to extravasation into the corpus spongiosum and surrounding veins, resulting in urinary tract infection and sepsis 14 …”