Sono-Urethrography in the Evaluation of Anterior Urethral Strictures

Abstract

During a 7-year period 123 paired urethrographic and sono-urethrographic studies were performed on 101 patients with 110 urethral strictures. In all but 3 cases the urethra was subsequently evaluated either cystoscopically or at open operation. Sono-urethrography readily identified urethral calculi, diverticula and false passages. It correctly identified the stricture and its site in every case. There was a significant difference between stricture length as measured by urethrography compared to that measured by sono-urethrography (p < 0.003). However, if the strictures were grouped based on anatomical location, there was good correlation and no significant difference in the penile urethra (correlation coefficient = 0.94, p = 0.74) but poor correlation and the significant difference remained in the urethral bulb (correlation coefficient = 0.64, p < 0.007). Similarly, when urethrographic and sono-urethrographic stricture lengths were compared with operative lengths, in the penile urethra the correlation coefficients were close (correlation coefficient = 0.91 versus 0.98) but in the urethral bulb the poor correlation persisted (correlation coefficient = 0.69 versus 0.89). Although sono-urethrography certainly identifies periurethral tissue, it was unreliable in predicting the depth of spongiofibrosis when compared with full depth biopsies in 36 patients with histopathological correlation. Finally, in 16% of the patients sono-urethrography correctly indicated a reconstructive procedure different from that originally suggested by conventional urethrography. Sono-urethrography is a dynamic 3-dimensional study that accurately identifies stricture site, number and caliber. Compared with conventional urethrography, it more accurately measures stricture length and diameter, and identifies periurethral tissue, making it a valuable adjunct in the evaluation of patients with suspected anterior urethral strictures.

Dorsal onlay (Barbagli technique) versus dorsal inlay (Asopa technique) buccal mucosal graft urethroplasty for anterior urethral stricture: A prospective randomized study

“…Urethral sonography is unreliable in diagnosing the depth of spongiofibrosis in comparison with histopathological correlation. 16 In the present study, BMG dorsal onlay urethroplasty and BMG dorsal Inlay urethroplasty provided comparable outcomes for anterior urethral strictures repair. We reported a success rate of 88% in the dorsal onlay group, whereas the success rate in the dorsal inlay group was 86.4%.…”

Urethroplasty; Wide Range of Therapeutic Indications and Surgical Techniques

“…First described by the McAninch et al in 1988 [29], urethral ultrasound(UU) to identify stricture has a reported sensitivity of 66% to 100%, specificity of 97% to 98%, and positive and negative predictive values of 50% to 80% and 96% to 98% respectively for anterior stricture 3 to 5 cm long. The usefulness of UU is limited by stricture location as it is more sensitive to stricture in the penile urethra than in bulbar portion [30]. It is also user dependency and the semi-invasive nature of the procedure often requiring local or general anesthesia for full urethra distention.…”

Comparison of radiographic and sonographic urethrography for assessing urethral strictures

“…It has been reported that SUG provides more accurate measurement of stricture length [4,5,6,7,8,9,10], and gives additional information about the depth and density of peri-urethral changes [3,4,5,8] not provided by RUG [11,12], which is helpful when treatment is chosen [13,14,15,16]. In contrast, RUG has been reported to underestimate stricture length [4,5,6,7,8,9,16], and is presumed to be responsible for inappropriate treatment selection and recurrence. More reconstructive surgery was indicated after SUG.…”

“…SUG directly identified a stricture by non-compressibility of spongiosum, altered echogenicity and changes in the peri-urethral tissue. Spongiofibrosis appears as hyperechoic [9] or even calcified with stronger reflection zone [3,4]. In 13 patients with long, severe strictures, sonographic contrast medium (200 microparticles/ml; Levovist, Schering, Berlin, Germany) was injected intra-urethrally to help delineate the abnormal lumen from the surrounding tissues and associated abnormalities-secondary lumen, fistulae, reflux into Cowper's glands and abscess.…”

“…The management chosen by the surgeons, was compared with that suggested by the imaging findings. The recent literature recommends reconstructive surgery [9,10,13,16,17,18,19,20,21] for strictures classified as severe or moderate or more than 1 cm long, or which involve the membranous urethra or are complicated. Descriptive analysis, Wilcoxon tests of pairs and regression analysis were made by SPSS (version 9).…”