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Fiedler G, Bittencourt LK, Zhou C, Cavalcanti AG, Goldman SM. Magnetic resonance imaging of the urethra. Radiol Bras 2023; 56:343-345. [PMID: 38504817 PMCID: PMC10948158 DOI: 10.1590/0100-3984.2023.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/05/2023] [Accepted: 10/23/2023] [Indexed: 03/21/2024] Open
Affiliation(s)
- Gustavo Fiedler
- Department of Diagnostic Imaging, Escola Paulista de Medicina da
Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP,
Brazil
| | | | - Christopher Zhou
- School of Medicine, Case Western Reserve University, Cleveland, OH,
USA
| | | | - Suzan Menasce Goldman
- Department of Diagnostic Imaging, Escola Paulista de Medicina da
Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP,
Brazil
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Harris D, Zhou C, Girardot J, Kidron A, Gupta S, Cavalcanti AG, Bittencourt LK. Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI. Abdom Radiol (NY) 2023; 48:1062-1078. [PMID: 36707430 DOI: 10.1007/s00261-022-03761-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 01/29/2023]
Abstract
Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.
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Affiliation(s)
- Daniel Harris
- Case Western Reserve University School of Medicine, Cleveland, OH, USA. .,Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
| | - Christopher Zhou
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jeffrey Girardot
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Ariel Kidron
- Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA
| | - Shubham Gupta
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA.,Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Andre Guilherme Cavalcanti
- Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Department of General and Specialized Surgery, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Kayat Bittencourt
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Anastomotic Urethroplasty with Double Layer Continuous Running Suture Re-Anastomosis Versus Interrupted Suture Re-Anastomosis for Infective Bulbar Urethral Strictures: A Prospective Randomised Trial. J Clin Med 2022; 11:jcm11154252. [PMID: 35893343 PMCID: PMC9332494 DOI: 10.3390/jcm11154252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/29/2022] [Accepted: 07/12/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: The objective of this study was to compare a double-layer running suture re-anastomosis urethral stricture repair with early catheter removal to the conventional interrupted suture re-anastomosis after excision of a bulbar urethral stricture. Methods: A consecutive series of patients with bulbar urethral stricture were enrolled in the study. The patients were randomized into two groups according to an odd/even serial number distribution. Patients’ medical records were analyzed for demographics, stricture characteristics, and lower urinary tract obstructive symptoms. The outcomes were based on the presence/absence of obstructive voiding symptoms, and retrograde urethrography (RGU) performed on the first post-operative day in Group 1 and in both groups (Groups 1 and 2) at six weeks after surgery. Flexible urethroscopy was only performed on specific cases where RGU was unclear both pre- and post-operatively or when clinical recurrence was suspected. The minimum follow-up (FU) was 18 months. Success was defined as no need for subsequent dilatation, direct vision internal urethrotomy (DVIU), or urethroplasty. Results: A total of thirty-six patients with a mean age of 45 years (range 20 to 69 years) with bulbar urethral stricture were included in this study. Group 1 and Group 2 included 19 and 17 patients, respectively. Two patients were lost during randomization and subsequently to FU. The average stricture lengths were comparable between the two groups according to the retrograde urethrogram: 1.20 cm (range 0.6 to 2) in Group 1 and 1.27 cm (range 0.5 to 2.4) in Group 2, respectively (p = 0.631). The success rate for Group 1 was 90% after a mean follow-up of thirty-six months (range 20 to 40), which was clinically significant compared to the 71% in Group 2 after a mean FU of thirty-three months (range 19 to 40; p = 0.0218; 95% CI: 0.462–41.5766). Conclusions: Anastomotic urethroplasty (AR) performed with a double layer re-anastomosis had a cure rate comparable to the conventional anastomosis with interrupted sutures after a follow-up of eighteen months and longer. The urethral catheter can be safely removed within twenty-four hours after the excision of stricture and double-layer re-anastomosis.
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Fahmy A, Elgebaly O, Elsawy MM, Orabi S. Role of tadalafil in enhancing visualization of posterior urethra prior to combined voiding cystourethrogram and retrograde urethrogram: a retrospective analysis. Abdom Radiol (NY) 2021; 46:4332-4337. [PMID: 33983471 DOI: 10.1007/s00261-021-03109-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To show utility of tadalafil in enhancing visualization of posterior urethra in patients with urethral stricture. METHODS We retrospectively reviewed the records of adults male who failed to delineate the posterior urethra while undergoing combined voiding cystourethrogram and retrograde urethrogram (VCUG and RUG), as a part of preoperative assessment of stricture length and location before urethral reconstruction. The study was repeated 24 h later after a single dose of tadalafil 20 mg was administrated 2 h before the procedure (Tadalafil group). A control group who did not receive any medication was used for comparison (control group). This study was carried out in between March 2016 and August 2019. RESULTS Thirty patients were included in the tadalafil group and equal number of patients was used as control group for comparison. The etiologies of strictures were pelvic fracture urethral distraction defect (39 patients), bulbar stricture with complete obliteration (15 patients) and post catheterization (6 patients). Success rate of opening bladder outlet on initiation of voiding was 90% in tadalafil group and 40% in the control group (P = 0.0004). None of the men reported any serious adverse events after oral administration of the drug. Almost all AEs were mild and well-tolerated. CONCLUSION Tadalafil effectively relaxes the bladder neck and the posterior urethra prior to combined VCUG and RUG in urethral stricture patients. Tadalafil was safe with no serious adverse effects when administered prior to performing the test. This prevents the patients from undergoing further invasive or expensive diagnostic techniques, moreover, tadalafil assisted in preoperative surgical preparation and patient's counseling.
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Sheehan JL, Naringrekar HV, Misiura AK, Deshmukh SP, Roth CG. The pre-operative and post-operative imaging appearances of urethral strictures and surgical techniques. Abdom Radiol (NY) 2021; 46:2115-2126. [PMID: 33386912 DOI: 10.1007/s00261-020-02879-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/28/2022]
Abstract
Urethral strictures arise from a variety of etiologies, most commonly either iatrogenic or inflammatory in the anterior urethra and iatrogenic/surgical or traumatic etiologies in the posterior urethra. Diagnosis and treatment planning depend on urethrography, usually performed with a combination of retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to evaluate the anterior and posterior urethra, respectively. While this is most commonly performed fluoroscopically, sonographic urethrography is an alternative, although at the expense of the posterior urethra, it is only visualized using a transrectal approach. In addition to understand urethral anatomy, familiarity with normal periurethral structures is necessary to avoid misdiagnosis, such as Cowper's ducts, the glands of Littré, and the prostatic and ejaculatory ducts. Surgical management depends on the stricture location, length, and number and options range from balloon dilatation to endoscopic urethrotomy to anastomotic and substitution urethrotomy. Postprocedural management includes urethrography to identify potential complications including urethral leak, graft failure, and stricture recurrence.
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Affiliation(s)
- Jamey L Sheehan
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Haresh V Naringrekar
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Anne Kathryn Misiura
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Sandeep P Deshmukh
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher G Roth
- Department of Radiology, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
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Ayoob A, Dawkins A, Gupta S, Nair R. Anterior urethral strictures and retrograde urethrography: An update for radiologists. Clin Imaging 2020; 67:37-48. [PMID: 32516692 DOI: 10.1016/j.clinimag.2020.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 04/01/2020] [Accepted: 05/13/2020] [Indexed: 11/18/2022]
Abstract
Urethral strictures are a relatively common affliction of men with the anterior urethra being most frequently affected. Anterior urethral strictures (AUS) typically present with obstructive voiding symptoms and appropriate management is often based on findings at cystourethroscopy and retrograde urethrography (RUG). In particular, determining the number, length, severity and location of urethral strictures is of pivotal importance. The accurate reporting of findings at RUG is dependent on a thorough knowledge of the urethral anatomy as well as recognizing periurethral structures that may opacify during the procedure. Obtaining a diagnostic, high-quality RUG study requires adherence to proper fluoroscopic technique as well as recognizing when to adjust or modify the technique to address pitfalls that may be encountered during the procedure. AUS may be treated by a variety of procedures including urinary diversion, transurethral procedures such as urethral dilation and internal urethrotomy and open surgical repair techniques termed urethroplasty. Some authors have recommended urethroplasty as first-line treatment given the high rate of stricture recurrence with other treatment options. Buccal mucosal grafts are a mainstay of modern urethroplasty. Familiarity with the commonly performed urethroplasty procedures allows radiologists to accurately assess the post-operative urethra thus guiding the management of these patients.
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Affiliation(s)
- Andres Ayoob
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0293, United States of America
| | - Adrian Dawkins
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0293, United States of America.
| | - Shubham Gupta
- Department of Radiology, University Hospitals, Cleveland, 11100 Euclid Ave, Cleveland, OH, United States of America
| | - Rashmi Nair
- Department of Radiology, University of Kentucky, 800 Rose Street, Lexington, KY 40536-0293, United States of America
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Childs DD, Dyer RB, Holbert B, Terlecki R, Chouhan JD, Ou J. Multimodality imaging of the male urethra: trauma, infection, neoplasm, and common surgical repairs. Abdom Radiol (NY) 2019; 44:3935-3949. [PMID: 31440803 DOI: 10.1007/s00261-019-02127-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The aim of this article is to describe the indications and proper technique for RUG and MRI, their respective image findings in various disease states, and the common surgical techniques and imaging strategies employed for stricture correction. RESULTS Because of its length and passage through numerous anatomic structures, the adult male urethra can undergo a wide array of acquired maladies, including traumatic injury, infection, and neoplasm. For the urologist, imaging plays a crucial role in the diagnosis of these conditions, as well as complications such as stricture and fistula formation. While retrograde urethrography (RUG) and voiding cystourethrography (VCUG) have traditionally been the cornerstone of urethral imaging, MRI has become a useful adjunct particularly for the staging of suspected urethral neoplasm, visualization of complex posterior urethral fistulas, and problem solving for indeterminate findings at RUG. CONCLUSIONS Familiarity with common urethral pathology, as well as its appearance on conventional urethrography and MRI, is crucial for the radiologist in order to guide the treating urologist in patient management.
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Affiliation(s)
- David D Childs
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Ray B Dyer
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Brenda Holbert
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Ryan Terlecki
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Jyoti Dee Chouhan
- Department of Urology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Jao Ou
- Department of Radiology, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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The Benefits of Using a Small Caliber Ureteroscope in Evaluation and Management of Urethral Stricture. Adv Urol 2018; 2018:9137892. [PMID: 30584423 PMCID: PMC6280311 DOI: 10.1155/2018/9137892] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/08/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction and Objective The proper evaluation of urethral strictures is an essential part of the surgical planning in urethral reconstruction. The proper evaluation of the stricture can be challenging in certain situations, especially when the meatus is involved. We propose that the use of a small caliber ureteroscope (4.5 Fr and 6.5 Fr) can offer additional help and use for the surgical planning in urethroplasty. Methods We prospectively collected data on 76 patients who underwent urethroplasties in Kulkarni Reconstructive Urology Center, Pune, India and Thunder Bay Regional Health Sciences Center, Thunder Bay, Canada. Patients had retrograde and micturition urethrograms performed preoperatively. The stricture was assessed visually using a 6.5 Fr ureteroscope. If the stricture was smaller than 6.5 Fr, we attempted using the 4.5 Fr ureteroscope. In nonobliterated strictures, we attempted bypassing the stricture making sure not to dilate the stricture. A glide wire would be passed to the bladder under vision. Stricture length, tissue quality, presence of other proximal strictures, false passages, and bladder tumors or stones would be assessed visually. If the penile stricture was near obliterative (smaller than 4.5 Fr caliber), a two-staged procedure is elected to be performed. For proximal bulbar strictures, if the urethral caliber is less than 4.5 Fr and the stricture length is less than 1 cm, we perform a nontransecting anastomotic urethroplasty (NTAU). If the stricture length is >1 cm, we perform a double-face augmented urethroplasty (DFAU). If the urethral caliber is >4.5 Fr and particularly those who are sexually active, ventral inlay with buccal mucosal grafts (BMGs) is performed. In mid to distal bulbar strictures, if the urethral caliber is >4.5 Fr, our procedure of choice is dorsal onlay with BMG. For those with urethral caliber <4.5 Fr and a stricture less than 1 cm, we perform a NTAU. For strictures longer than 1 cm, we perform a DFAU. With the exception of trauma, we very rarely transect the urethra. For panurethral strictures, we almost exclusively perform Kulkarni one-sided dissection. Results Urethroscopy was performed in 76 patients who presented for urethroplasty from July 2014 to September 2014 (in Pune) and between April 2016 and September 2017 (in Thunder Bay). Bypassing the stricture was achieved in 68 patients (89%) while it was unsuccessful in 8 patients (11%). In all unsuccessful urethroscopies, the stricture was near obliterative <4.5 Fr. Our surgical planning changed in (13) 17% of the cases. Out of 43 bulbar strictures, the decision was changed in (9) 21% where we performed 4 DFAU, 3 AAU (augmented anastomotic urethroplasty), and 2 EAU (end anastomotic urethroplasty). In 13 penile strictures, we opted for staged urethroplasty including 3 Johansons and 1 first-stage Asopa in 30.7%. In 20 panurethral urethroplasties, 1 patient (5%) had a urethral stone found in a proximal portion of the bulbar urethra distal to a stricture ring that was removed using an endoscopic grasper. Conclusion The use of the small caliber ureteroscope can help in evaluation of the stricture caliber, length, and tissue quality. The scope can also aid in placing a guide wire, evaluating the posterior urethra, and screening for urethral or bladder stones. It can also improve the preoperative patient counselling and avoid unwanted surprises.
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Su Y, Fang K, Mao C, Xiang S, Wang J, Li Y. 640-slice DVCT multi-dimensionally and dynamically presents changes in bladder volume and urine flow rate. Exp Ther Med 2018; 15:2557-2562. [PMID: 29467853 DOI: 10.3892/etm.2017.5671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 09/06/2017] [Indexed: 11/05/2022] Open
Abstract
The present study aimed to explore the application of 640-slice dynamic volume computed tomography (DVCT) to excretory cystography and urethrography. A total of 70 healthy subjects were included in the study. Excretory cystography and urethrography using 640-slice DVCT was conducted to continuously record the motions of the bladder and the proximal female and male urethra. The patients' voiding process was divided into early, early to middle, middle, middle to late, and late voiding phases. The subjects were analyzed using DVCT and conventional CT. The cross-sectional areas of various sections of the male and female urethra were evaluated, and the average urine flow rate was calculated. The 640-slice DVCT technique was used to dynamically observe the urine flow rate and changes in bladder volume at all voiding phases. The urine volume detected by 640-slice DVCT exhibited no significant difference compared with the actual volume, and no significant difference compared with that determined using conventional CT. Furthermore, no significant difference in the volume of the bladder at each phase of the voiding process was detected between 640-slice DVCT and conventional CT. The results indicate that 640-slice DVCT can accurately evaluate the status of the male posterior urethra and female urethra. In conclusion, 640-slice DVCT is able to multi-dimensionally and dynamically present changes in bladder volume and urine flow rate, and could obtain similar results to conventional CT in detecting urine volume, as well as the status of the male posterior urethra and female urethra.
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Affiliation(s)
- Yunshan Su
- Department of Radiology, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Kewei Fang
- Department of Urology, The Second Hospital of Kunming Medical University, Kunming, Yunnan 650101, P.R. China
| | - Chongwen Mao
- Department of Radiology, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Shutian Xiang
- Department of Radiology, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Jin Wang
- Department of Radiology, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
| | - Yingwen Li
- Department of Radiology, The Second People's Hospital of Yunnan Province, Kunming, Yunnan 650021, P.R. China
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Horiguchi A, Edo H, Soga S, Shinchi M, Masunaga A, Ito K, Asano T, Shinmoto H, Azuma R. Pubourethral Stump Angle Measured on Preoperative Magnetic Resonance Imaging Predicts Urethroplasty Type for Pelvic Fracture Urethral Injury Repair. Urology 2018; 112:198-204. [DOI: 10.1016/j.urology.2017.09.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 09/15/2017] [Accepted: 09/19/2017] [Indexed: 01/24/2023]
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Pandian RM, John NT, Eapen A, Antonisamy B, Devasia A, Kekre N. Does MRI help in the pre - operative evaluation of pelvic fracture urethral distraction defect? - A pilot study. Int Braz J Urol 2017; 43:127-133. [PMID: 28124535 PMCID: PMC5293393 DOI: 10.1590/s1677-5538.ibju.2016.0252] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 06/29/2016] [Indexed: 11/22/2022] Open
Abstract
Objectives To study the usefulness of MRI in preoperative evaluation of PFUDD. Can MRI provide additional information on urethral distraction defect (UDD) and cause of erectile dysfunction (ED)? Materials and Methods In this prospective study, consecutive male patients presenting with PFUDD were included from Feb 2011 till Dec 2012. Those with traumatic spinal cord injury and pre-existing ED were excluded. Patients were assessed using IIEF questionnaire, retrograde urethrogram and micturating cystourethrogram (RGU+MCU) and MRI pelvis. Primary end point was erectile function and secondary end point was surgical outcome. Results Twenty patients were included in this study. Fourteen patients (70%) were ≤40years; fifteen patients (75%) had ED, seven patients (35%) had severe ED. MRI findings associated with ED were longer median UDD (23mm vs. 15mm, p=0.07), cavernosal injury (100%, p=0.53), rectal injury (100%, p=0.53), retropubic scarring (60%, p=0.62) and prostatic displacement (60%, p=0.99). Twelve patients (60%) had a good surgical outcome, five (25%) had an acceptable outcome, three (15%) had a poor outcome. Poor surgical outcome was associated with rectal injury (66.7%, p=0.08), cavernosal injury (25%, p=0.19), retropubic scarring (18.1%, p=0.99) and prostatic displacement (16.7%, p=0.99). Five patients with normal erections had good surgical outcome. Three patients with ED had poor outcome (20%, p=0.20). Conclusions MRI did not offer significant advantage over MCU in the subgroup of men with normal erections. Cavernosal injury noted on MRI strongly correlated with ED. Role of MRI may be limited to the subgroup with ED or an inconclusive MCU.
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Affiliation(s)
| | - Nirmal Thampi John
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Anu Eapen
- Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - B Antonisamy
- Department of Biostatistics, Christian Medical College and Hospital, Tamil Nadu, India
| | - Antony Devasia
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Nitin Kekre
- Department of Urology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Shahsavari R, Bagheri SM, Iraji H. Comparison of Diagnostic Value of Sonourethrography with Retrograde Urethrography in Diagnosis of Anterior Urethral Stricture. Open Access Maced J Med Sci 2017; 5:335-339. [PMID: 28698753 PMCID: PMC5503733 DOI: 10.3889/oamjms.2017.073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 03/22/2017] [Accepted: 04/04/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In spite of the advanced imaging methods, MRI and CT-Scan, the role of ultrasonography is still unique in some fields of genitourinary tract diseases. AIM This study was aimed at assessing this role in the evaluation of male urinary stricture, and comparison with standard retrograde urethrography (SUG). METHODS This was a cross-sectional study. The patients include those who were suspected of anterior urethral stricture and were introduced assessed with imaging techniques (RUG). The patient underwent ultrasonography too. The results of both methods were compared. RUG was considered as the gold standard for this comparison. RESULT Ninety-seven patients were studied. The mean age was 46.9 ± 11.7 years (range 21-88 years), in RUG, 22 patients (22.8%) and SUG 23 patients (23.7%) had a stricture, 3 cases with a stricture in RUG had not evidenced of stenosis in SUG. The mean length of urethral stricture in RUG was 12.9 ± 8.1 mm and in SUG was 8.1 ± 7.3 mm. The estimated length in RUG way was significantly higher than SUG way (P=0.025). The sensitivity and specificity in using of SUG were 86.6% and 94.6%, respectively. CONCLUSION The result of this study showed stricture length measured by ultrasound is shorter than the length measured by RUG and the sensitivity and specificity in using of SUG was 86.6% and 94.6% respectively that due to the advantages it is an acceptable way.
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Affiliation(s)
- Reza Shahsavari
- Resident of Radiology, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Morteza Bagheri
- Department of Radiology, Hasheminejad Kidney Center (HKC), Iran University of Medical Sciences, Tehran, Iran
| | - Hamed Iraji
- Resident of Radiology, Iran University of Medical Sciences, Tehran, Iran
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Abstract
Urethral stricture/stenosis is a narrowing of the urethral lumen. These conditions greatly impact the health and quality of life of patients. Management of urethral strictures/stenosis is complex and requires careful evaluation. The treatment options for urethral stricture vary in their success rates. Urethral dilation and internal urethrotomy are the most commonly performed procedures but carry the lowest chance for long-term success (0–9%). Urethroplasty has a much higher chance of success (85–90%) and is considered the gold-standard treatment. The most common urethroplasty techniques are excision and primary anastomosis and graft onlay urethroplasty. Anastomotic urethroplasty and graft urethroplasty have similar long-term success rates, although long-term data have yet to confirm equal efficacy. Anastomotic urethroplasty may have higher rates of sexual dysfunction. Posterior urethral stenosis is typically caused by previous urologic surgery. It is treated endoscopically with radial incisions. The use of mitomycin C may decrease recurrence. An exciting area of research is tissue engineering and scar modulation to augment stricture treatment. These include the use of acellular matrices or tissue-engineered buccal mucosa to produce grafting material for urethroplasty. Other experimental strategies aim to prevent scar formation altogether.
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Bryk DJ, Khurana K, Yamaguchi Y, Kozirovsky M, Telegrafi S, Zhao LC. Outpatient Ultrasound Urethrogram for Assessment of Anterior Urethral Stricture: Early Experience. Urology 2016; 93:203-7. [DOI: 10.1016/j.urology.2016.03.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/07/2016] [Accepted: 03/08/2016] [Indexed: 11/29/2022]
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Abstract
Introduction: Broadly defined, urethral strictures are narrowing of the urethral lumen that is surrounded by corpus spongiosum, i.e., urethral meatus through the bulbar urethra. Urethral stenosis is narrowing of the posterior urethra, i.e., membranous urethra through bladder neck/prostate junction, which is not enveloped by corpus spongiosum. The disease has significant quality of life ramifications because many times younger patients are affected by this compared to many other urological diseases. Methods: A review of the scientific literature concerning urethral stricture, stenosis, treatment, and outcomes was performed using Medline and PubMed (U.S. National Library of Medicine and the National Institutes of Health). Abstracts from scientific meetings were included in this review. Results: There is level 3 evidence regarding the etiology and epidemiology of urethral strictures, stenoses, and pelvic fracture urethral injuries. Outcomes data from literature regarding intervention for urethral stricture are largely limited to level 3 evidence and expert opinion. There is a single level 1 study comparing urethral dilation and direct vision internal urethrotomy. Urethroplasty outcomes data are limited to level 3 case series. Conclusions: Progress is being made toward consistent terminology, and nomenclature which will, in turn, help to standardize treatment within the field of urology. Treatment for urethral stricture and stenosis remains inconsistent between reconstructive and nonreconstructive urologists due to varying treatment algorithms and approaches to disease management. Tissue engineering appears to be future for reconstructive urethral surgery with reports demonstrating feasibility in the use of different tissue substitutes and grafts.
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Affiliation(s)
- Thomas G Smith
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA
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16
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Abstract
Accurate imaging of urethral strictures is critical for preoperative staging and planning of reconstruction. The current gold standard, retrograde urethrography (RUG), allows for accurate diagnosis, staging, and delineation of urethral strictures, and remains a cornerstone in the management of urethral stricture disease. In complex situations, the RUG can be combined with voiding cystourethrogram (VCUG) in order to better visualize the posterior urethra or complex distraction defects. Direct visualization of the stricture by cystoscopy, either retrograde or antegrade, can provide additional information as to the location and appearance of stricture, as well as precise location on fluoroscopic imaging. Sonourethrography (SU) is a useful adjunct to allow for three-dimensional assessment of stricture length and location, and can be a useful intraoperative assessment tool, however, its use remains limited to a second-line setting. Cross-sectional imaging in the form of computed tomography (CT) or magnetic resonance urethrography can provide additional three-dimensional information of anatomic structures and their relations, and can serve as a useful adjunct in complex clinical scenarios.
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Affiliation(s)
- Conrad Maciejewski
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Ravikumar BR, Tejus C, Madappa KM, Prashant D, Dhayanand GS. A comparative study of ascending urethrogram and sono-urethrogram in the evaluation of stricture urethra. Int Braz J Urol 2015; 41:388-92. [PMID: 26005985 PMCID: PMC4752107 DOI: 10.1590/s1677-5538.ibju.2015.02.30] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 09/18/2014] [Indexed: 11/21/2022] Open
Abstract
To compare the efficacy of sono-urethrogram and ascending urethrogram in the evaluation of stricture urethra.
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Affiliation(s)
- B R Ravikumar
- JSS Medical college and hospital, Mysore, Karnataka, India
| | | | - K M Madappa
- JSS Medical college and hospital, Mysore, Karnataka, India
| | | | - G S Dhayanand
- JSS Medical college and hospital, Mysore, Karnataka, India
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Magnetic resonance urethrography versus conventional retrograde urethrography in the evaluation of urethral stricture: Comparison with surgical findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2014.10.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Bach P, Rourke K. Independently interpreted retrograde urethrography does not accurately diagnose and stage anterior urethral stricture: the importance of urologist-performed urethrography. Urology 2014; 83:1190-3. [PMID: 24767528 DOI: 10.1016/j.urology.2013.12.063] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/29/2013] [Accepted: 12/31/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To compare the accuracy of retrograde urethrogram (RUG) interpretation between the primary physician performing the procedure and the independent physician interpreting the films to evaluate the suitability of relying on independent physician interpretations for the purposes of preoperative urethral stricture surgery planning. METHODS A retrospective review was performed on a cohort of 397 patients undergoing anterior urethroplasty over a 7-year period at a single center. Preoperative RUG findings as reported at the time by both the urologist performing the urethrography and the independent interpreter (radiologist) were abstracted and compared with stricture location and length as measured intraoperatively. RUG adequacy was defined as a comment on the presence, location, and length of the urethral stricture. RESULTS Only 49% of independently reported RUG studies were deemed adequate, and 87% of independently reported studies correctly diagnosed the presence of a stricture. Forty-nine percent of independently reported studies correctly identified stricture location compared with 96% of primary physician-reported cases (P <.001). The reported stricture lengths were 3.23 ± 2.25, 4.19 ± 2.49, and 4.51 ± 2.65 cm for the independently reported RUGs, primary physician-reported RUGs, and the intraoperative measurements, respectively. Differences between all the groups were statistically significant (P <.001). Independently reported length had a 0.47 R(2) coefficient of correlation to the intraoperative length (P <.001) compared with a 0.93 R(2) coefficient of correlation between primary physician-reported length and intraoperative length (P <.001). CONCLUSION Independently reported RUGs are not as accurate as primary physician-reported RUGs, and caution should be used when they are used for preoperative planning.
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Affiliation(s)
- Phil Bach
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Keith Rourke
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.
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20
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Eswara JR, Song JB, Chang AJ, Rosenstein DI, Gonzalez CM, Vetter JM, Brandes SB. Urethrography interpretation skills of urology and radiology residents at tertiary care medical centers. Urology 2014; 83:1239-42. [PMID: 24768017 DOI: 10.1016/j.urology.2014.02.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 02/20/2014] [Accepted: 02/28/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the ability of urology and radiology residents to interpret retrograde urethrograms (RUGs) and voiding cystourethrograms (VCUGs). METHODS A standardized examination of 10 combination RUGs and VCUGs of the male urethra was administered to urology and radiology residents from all levels of training at Washington University, Stanford University, and Northwestern University. Residents were asked to evaluate stricture location(s) and length, if present. RESULTS Sixty residents participated, consisting of 26 from Washington University, 15 from Stanford University, and 19 from Northwestern University. Average years of training for urology and radiology were 3.6 and 2.8 years, respectively (P=.01). Normal RUGs and VCUGs were recognized by 18 of 31 radiologists (58%) and 19 of 29 urologists (65.5%; P=.5). Anterior strictures were correctly identified in 145 of 403 (36%) and 165 of 377 (43.8%) responses by radiologists and urologists, respectively (P=.03). Posterior strictures were correctly identified in 20 of 62 (32.3%) and 10 of 58 (17.2%) responses by radiologists and urologists, respectively (P=.09). When both groups of residents were combined, anterior strictures were identified correctly more often than posterior strictures (39.7% vs 25%; P<.01). Overall accuracy was 24.2% (75 of 310) for the radiology group and 27.9% (81 of 290) for the urology group (P=.30). In the presence of multiple strictures, accuracy declined to 7.26% (9 of 124) for the radiology group and 9.48% (11 of 116) for the urology group (P=.5), with a combined accuracy of 8.33% (20 of 240). CONCLUSION Radiology and urology residents in the United States have poor skills at interpreting urethrography, especially when multiple strictures or posterior strictures are present. A formal educational program for RUG and VCUG interpretation should be designed and implemented into the radiology and urology resident curriculum.
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Affiliation(s)
- Jairam R Eswara
- Division of Urologic Surgery, School of Medicine, Washington University in St Louis, St Louis, MO.
| | - Joseph B Song
- Division of Urologic Surgery, School of Medicine, Washington University in St Louis, St Louis, MO
| | - Andrew J Chang
- Division of Urologic Surgery, School of Medicine, Washington University in St Louis, St Louis, MO
| | | | - Christopher M Gonzalez
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Joel M Vetter
- Division of Urologic Surgery, School of Medicine, Washington University in St Louis, St Louis, MO
| | - Steven B Brandes
- Division of Urologic Surgery, School of Medicine, Washington University in St Louis, St Louis, MO
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21
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Orabi H, Aboushwareb T, Tan J, Yoo JJ, Atala A. Can Computed Tomography--assisted Virtual Endoscopy Be an Innovative Tool for Detecting Urethral Tissue Pathologies? Urology 2014; 83:930-8. [PMID: 24485996 DOI: 10.1016/j.urology.2013.11.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/27/2013] [Accepted: 11/04/2013] [Indexed: 02/08/2023]
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Angermeier KW, Rourke KF, Dubey D, Forsyth RJ, Gonzalez CM. SIU/ICUD Consultation on Urethral Strictures: Evaluation and follow-up. Urology 2013; 83:S8-17. [PMID: 24275285 DOI: 10.1016/j.urology.2013.09.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Revised: 08/22/2013] [Accepted: 09/13/2013] [Indexed: 10/26/2022]
Abstract
For the 2010 International Consultation on Urethral Strictures, all available published data relating to the evaluation and follow-up of patients with anterior urethral stricture or posterior urethral stenosis were reviewed and evaluated. Selected manuscripts were classified by Level of Evidence using previously established criteria. Consensus was achieved through group discussion, and formal recommendations were established and graded on the basis of levels of evidence and expert opinion. Retrograde urethrography remains the de facto standard for the evaluation of patients with urethral stricture. It can readily be combined with voiding cystourethrography to achieve a synergistic evaluation of the entire urethra, and this approach is currently recommended as the optimal method for pretreatment staging. Cystoscopy is recommended as the most specific procedure for the diagnosis of urethral stricture and is a useful adjunct in the staging of anterior urethral stricture, particularly to confirm abnormal or equivocal findings on imaging studies. Cystoscopy is also an important modality for assessing the bladder neck and posterior urethra in the setting of a pelvic fracture-related urethral injury. Although urethrography and cystoscopy remain the principle forms of assessment of the patient with urethral stricture, additional adjuncts include uroflowmetry, symptom scores, quality of life assessments, ultrasonography, computed tomography, and magnetic resonance imaging. These modalities might be helpful to further evaluate patients in select circumstances or provide a less invasive approach to monitoring outcomes after surgical treatment. Further research is needed to establish consensus opinion as to the definition of success after urethroplasty and to develop standardized patient outcome measures.
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Affiliation(s)
- Kenneth W Angermeier
- Center for Genitourinary Reconstruction, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH.
| | - Keith F Rourke
- Division of Urology, Department of Surgery, University of Alberta, Alberta, Canada.
| | - Deepak Dubey
- Manipal Institute of Urology and Nephrology, Manipal Hospital, Bangalore, India
| | - Robert J Forsyth
- Ballarat Urology, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Christopher M Gonzalez
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL
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23
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Venkatramani V, Mukha RP. Visualization of male reproductive tract during urethrography: sequel of intense backpressure. ANZ J Surg 2013; 85:393. [DOI: 10.1111/ans.12461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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24
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Kathpalia R, Dalela D, Goel A, Mandal S, Sankhwar SN, Yadav R, Nagathan D, Dalela D. Effect of Phallic Stretch on Length of Bulbous Urethral Stricture during Retrograde Urethrography. Urol Int 2013; 93:63-6. [DOI: 10.1159/000353228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 05/22/2013] [Indexed: 11/19/2022]
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Abstract
Imaging of the genitourinary tract is essential in the workup of the majority of the conditions seen daily by urologists. The use of ultrasound in the office provides a safe, low cost, and efficient way for the clinician to evaluate the patient in real time. Ultrasound can allow for bedside diagnosis in many conditions and assist in treatment planning. This chapter covers the major applications of office ultrasound for the urologist as well as discusses future applications of ultrasound for the office setting.
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Affiliation(s)
- Etai Goldenberg
- Hofstra North Shore-LIJ School of Medicine, The Arthur Smith Institute for Urology, New Hyde Park, NY 11042, USA.
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26
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Li X, Sa YL, Xu YM, Fu Q, Zhang J. Flexible Cystoscope for Evaluating Pelvic Fracture Urethral Distraction Defects. Urol Int 2012; 89:402-7. [DOI: 10.1159/000339926] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 05/28/2012] [Indexed: 11/19/2022]
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27
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Peng B, Yao MH, Wu R, Xie J, Xu HX. The clinical value of sonourethrography after bipolar transurethral plasmakinetic prostatectomy. MINIM INVASIV THER 2012; 22:122-6. [PMID: 22924472 DOI: 10.3109/13645706.2012.713365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Bo Peng
- Department of Urology, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Ming-Hua Yao
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Rong Wu
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Juan Xie
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
| | - Hui-Xiong Xu
- Department of Ultrasound in Medicine, Shanghai tenth People's Hospital, Tongji University School of Medicine,
Shanghai, China
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28
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Abstract
Imaging of the anterior male urethra has traditionally been performed by fluoroscopic contrast urethrography. While providing easily interpretable images, this technique has a number of disadvantages associated with it. An alternative approach is to use ultrasound to assess the lumen of the urethra and the periurethral tissues. Here we describe the development of urethral ultrasound and the ascending and descending urethral ultrasound techniques employed in our institution with reference to commonly and uncommonly encountered pathologies. We also identify common pitfalls and how to avoid them.
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Affiliation(s)
- N Shaida
- Department of Radiology, Addenbrookes Hospital, Cambridge, UK.
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29
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Abstract
Urethral strictures are difficult to manage. Some treatment modalities for urethral strictures are fraught with high patient morbidity and stricture recurrence rates; however, an extremely useful tool in the armamentarium of the Reconstructive Urologist is buccal mucosal urethroplasty. We like buccal mucosa grafts because of its excellent short and long-term results, low post-operative complication rate, and relative ease of use. We utilize it for most our bulbar urethral stricture repairs and some pendulous urethral stricture repairs, usually in conjunction with a first-stage Johanson repair. In this report, we discuss multiple surgical techniques for repair of urethral stricture disease. Diagnosis, evaluation of candidacy, surgical techniques, post-operative care, and complications are included. The goal is to raise awareness of buccal mucosa grafting for the management urethral stricture disease.
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Affiliation(s)
- W Britt Zimmerman
- The Detroit Medical Center and the Michigan State University, College of Osteopathic Medicine, MI, USA
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30
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Low-power holmium:YAG laser urethrotomy for urethral stricture disease: Comparison of outcomes with the cold-knife technique. Kaohsiung J Med Sci 2011; 27:503-7. [PMID: 22005159 DOI: 10.1016/j.kjms.2011.06.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 11/01/2010] [Indexed: 11/21/2022] Open
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Terlecki RP, Steele MC, Valadez C, Morey AF. Low Yield of Early Postoperative Imaging After Anastomotic Urethroplasty. Urology 2011; 78:450-3. [DOI: 10.1016/j.urology.2011.01.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/27/2011] [Accepted: 01/27/2011] [Indexed: 10/17/2022]
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Hanna SA, Abd El-Rahman SF, Barsoum NR, El Gammal MY. Role of MDCT in evaluation of urethral lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2011. [DOI: 10.1016/j.ejrnm.2011.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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33
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Buckley JC, Wu AK, McAninch JW. Impact of urethral ultrasonography on decision-making in anterior urethroplasty. BJU Int 2011; 109:438-42. [PMID: 21615851 DOI: 10.1111/j.1464-410x.2011.10246.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jill C Buckley
- Lahey Clinic Medical Center - Department of Urology, Burlington, MA 01805, USA.
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Diagnosis of male posterior urethral stricture: comparison of 64-MDCT urethrography vs. standard urethrography. ACTA ACUST UNITED AC 2010; 36:771-5. [DOI: 10.1007/s00261-010-9676-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Zimmerman WB, Santucci RA. A simplified and unified approach to anterior urethroplasty. Nat Rev Urol 2010; 7:386-91. [PMID: 20531384 DOI: 10.1038/nrurol.2010.79] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The management of patients with urethral stricture can be a complex process. However, with the appropriate tools, the urologist experienced in urethral surgery can manage most cases without too much difficulty. Here, we describe three surgical techniques--anastomotic urethroplasty, buccal mucosal graft-onlay urethroplasty and the two-staged Johanson urethroplasty--that, in our experience, can accommodate the majority of patients with urethral stricture and provide excellent long-term results. Diagnosis and evaluation of candidacy for each of the surgical techniques are important aspects of treatment planning, and are also described. The aim of the article is to increase the awareness of the technique and application of these three urethroplasty procedures, which can be implemented by all urologists who actively care for and surgically treat patients with urethral stricture disease.
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Affiliation(s)
- W Britt Zimmerman
- The Center for Urologic Reconstruction, Detroit Medical Center, Harper Professional Building, Suite 1017, 4160 John R Street, Detroit, MI 48201, USA
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36
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MR urethrogram versus combined retrograde urethrogram and sonourethrography in diagnosis of urethral stricture. Eur J Radiol 2010; 74:e193-8. [DOI: 10.1016/j.ejrad.2009.06.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 06/07/2009] [Accepted: 06/08/2009] [Indexed: 11/23/2022]
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Meeks JJ, Erickson BA, Granieri MA, Gonzalez CM. Stricture recurrence after urethroplasty: a systematic review. J Urol 2009; 182:1266-70. [PMID: 19683309 DOI: 10.1016/j.juro.2009.06.027] [Citation(s) in RCA: 147] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2009] [Indexed: 11/27/2022]
Abstract
PURPOSE Urethroplasty remains the gold standard for the management of urethral stricture disease with acceptable long-term success. However, the standard by which stricture recurrence is defined and evaluated after urethral reconstruction remains widely variable. We conducted a systematic review of the urological literature to determine how stricture recurrence is defined and evaluated. MATERIALS AND METHODS A systematic review was conducted on all contemporary urethroplasty articles published between 2000 and 2008. Using the term "urethroplasty" 302 articles were identified and evaluated. A total of 86 articles were included in the analysis. RESULTS The overall recurrence rate for all reconstructive procedures was 15.6%, which remained stable between 2000 and 2008. Stricture recurrence was determined by a mean of 3 (range 1 to 8) different diagnostic tests. The most common primary diagnostic tests for recurrence were uroflowmetry (56% of articles) and retrograde urethrography (51%). Cystourethroscopy was used as a primary screen to identify stricture recurrence in 25% of articles, and as a secondary procedure in another 21%. Recurrence was defined as the need for an additional surgical procedure or dilation in 75% and 52% of articles, respectively. CONCLUSIONS The methods used to determine stricture recurrence after urethroplasty remain widely variable. The use of a standardized surveillance protocol to define stricture recurrence after urethral reconstruction may allow more effective comparison of urethroplasty outcomes across institutions.
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Affiliation(s)
- Joshua J Meeks
- Department of Urology, Northwestern University, Feinberg School of Medicine, Chicago, Illinois 60611, USA
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KAMAT NAGESH, DASGUPTA RANAN, SHABBIR MAJID, NEULANDER ENDRZ, KLEIN JOSEPH, KANETI JACOB, JOSEPH JEANV, PATEL HITENDRAR, MCHUGH LYNSEYA, GRIFFITHS THOMASR, SHERGILL IQBALS, HAMID RIZWAN, GUPTA SUJOY, MAMMEN KIMJ, WALTON THOMASJ, MICELI PAULA. Dynamic three-dimensional spiral computed tomographic cysto-urethrography: a novel technique for evaluating post-traumatic posterior urethral defects. BJU Int 2008. [DOI: 10.1111/j.1464-410x.04949.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Latini JM. Minimally invasive treatment of urethral strictures in men. CURRENT BLADDER DYSFUNCTION REPORTS 2008. [DOI: 10.1007/s11884-008-0017-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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40
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Osman Y, El-Ghar MA, Mansour O, Refaie H, El-Diasty T. Magnetic Resonance Urethrography in Comparison to Retrograde Urethrography in Diagnosis of Male Urethral Strictures: Is It Clinically Relevant? Eur Urol 2006; 50:587-93; discussion 594. [PMID: 16457942 DOI: 10.1016/j.eururo.2006.01.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2005] [Accepted: 01/10/2006] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To compare the clinical relevance of retrograde urethrography (RUG) and magnetic resonance (MR) urethrography in evaluating male urethral strictures. METHODS Between January and April 2004, 20 men were referred to our institute for management of urethral strictures. The patients were investigated by conventional RUG and multiformat MR urethrography. The patients were examined by urethroscopy under anesthesia to be followed by definitive endoscopic or open operative intervention. The radiologic data were compared by endoscopic as well as operative findings in all the patients. RESULTS Ten patients were managed by visual internal urethrotomy (VIU) and two by dilatation under anesthesia; two showed normal urethral caliber. Four patients required open urethral reconstructive procedures. Two patients underwent radical cystectomy and cutaneous diversion because of associated bladder or urethral malignancy. Although overall accuracy for diagnosis of urethral strictures was equal between both modalities (85%), MR urethrography provided extra clinical data in seven patients (35%). It was superior to RUG in judging the urethral stricture length in three patients, diagnosing a urethral tumor in one, detecting associated bladder mass in one, characterizing the site of urethra-rectal fistula in one, and accurately delineating the proximal urethra in the last patient. Unlike RUG, MR urethrography provided adequate information about the degree of spongiofibrosis in all patients. CONCLUSION MR urethrography is a promising tool for defining male urethral strictures and can provide extra guidance for treatment planning that cannot be obtained with RUG.
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Affiliation(s)
- Yasser Osman
- Urology Department, Urology & Nephrology Center, Mansoura University, Mansoura, Egypt.
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41
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Jankowski JT, Spirnak JP. Current Recommendations for Imaging in the Management of Urologic Traumas. Urol Clin North Am 2006; 33:365-76. [PMID: 16829271 DOI: 10.1016/j.ucl.2006.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Three percent to 10% of trauma patients have genitourinary tract injuries. Radiologic imaging is essential for making the correct diagnosis and managing it appropriately. Which modality is appropriate is based on the mechanism of injury and patient presentation. Patients with pelvic injuries and gross hematuria should undergo either CT cystography or conventional cystography. Ultrasound is warranted in patients with scrotal trauma when physical exam is inconclusive. Patients with penetrating trauma to the external genitalia, who suffer blunt trauma to the penis, or who present with gross hematuria, blood at the meatus, inability to void, perineal/scrotal ecchymosis, or abnormal digital rectal exam should undergo retrograde urethrography. Using these criteria for imaging should lead to the proper diagnosis and minimize patient morbidity.
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Affiliation(s)
- Jason T Jankowski
- Department of Urology, Case Western Reserve University, MetroHealth Medical Center, 2500 MetroHealth Drive, Room H947, Cleveland, OH 44109, USA
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42
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Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King BF, Goldman SM. Imaging of urethral disease: a pictorial review. Radiographics 2005; 24 Suppl 1:S195-216. [PMID: 15486241 DOI: 10.1148/rg.24si045504] [Citation(s) in RCA: 159] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Retrograde urethrography and voiding cystourethrography are the modalities of choice for imaging the urethra. Cross-sectional imaging modalities, including ultrasonography, magnetic resonance (MR) imaging, and computed tomography, are useful for evaluating periurethral structures. Retrograde urethrography is the primary imaging modality for evaluating traumatic injuries and inflammatory and stricture diseases of the male urethra. Sonourethrography plays an important role in the assessment of the thickness and length of bulbar urethral stricture. Although voiding cystourethrography is frequently used to evaluate urethral diverticula in women, MR imaging is highly sensitive in the demonstration of these entities. MR imaging is also accurate in the local staging of urethral tumors.
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Affiliation(s)
- Akira Kawashima
- Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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La uretrografía como método diagnóstico en la patología benigna uretral. RADIOLOGIA 2005. [DOI: 10.1016/s0033-8338(05)72845-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Chou CP, Huang JS, Wu MT, Pan HB, Huang FD, Yu CC, Yang CF. CT Voiding Urethrography and Virtual Urethroscopy: Preliminary Study with 16-MDCT. AJR Am J Roentgenol 2005; 184:1882-8. [PMID: 15908546 DOI: 10.2214/ajr.184.6.01841882] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to demonstrate CT voiding urethrography and CT virtual urethroscopy. Fourteen CT voiding urethrography examinations on 13 men (mean age, 30 years) were prospectively performed with 16-MDCT. The clinical diagnoses of those patients included urethral injury, urethral stricture, and hypospadia. The CT voiding urethrogram was obtained with transverse CT of the voiding, contrast-filled urethra and display of 2D multiplanar and 3D virtual images. CONCLUSION The full urethral structure was clearly shown by CT voiding urethrography and virtual urethroscopy in all patients. The results of CT voiding urethrography and conventional methods correlated closely with the urethral diseases being imaged.
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Affiliation(s)
- Chen-Pin Chou
- Department of Radiology, Kaohsiung Veterans General Hospital, 386 Da-Chung First Rd., Kaohsiung 813, Taiwan, ROC
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Chitale SV, Haq A, Webb RJ. Vasography in urethral stricture: novel application of an old technique. SCANDINAVIAN JOURNAL OF UROLOGY AND NEPHROLOGY 2005; 39:234-6. [PMID: 16118097 DOI: 10.1080/00365590510007766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Urethral stricture disease in men has traditionally been investigated with ascending and voiding cystourethrography as well as urethroscopy. The main emphasis during the preoperative assessment is on establishing the exact extent of the disease process in order to plan appropriate management. We describe a technique that represents a novel approach to the assessment of proximal urethral stricture and in selected cases would be of immense help in defining its precise nature and planning definitive treatment.
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Affiliation(s)
- S V Chitale
- Department of Urology, Norfolk & Norwich University Hospital NHS Trust, Norwich, UK.
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Kröpfl D, Olschewski T, Seegenschmiedt MH. Endoluminale Brachytherapie zur Vorbeugung von rezidivierenden Strikturen nach Urethrotomia interna. Urologe A 2004; 43:1254-61. [PMID: 15278200 DOI: 10.1007/s00120-004-0630-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
METHODS AND MATERIALS Between November 2000 and December 2002 endoscopic incision or transurethral scar resection was followed by endourethral brachytherapy (BT) which was performed in patients with recurrent bulbar strictures ( n=9), bladder neck stenosis after transurethral prostatectomy (TUR-P) ( n=3), anastomotic stricture after radical prostatectomy ( n=2) or penile urethral stricture ( n=1). High dose rate (HDR) iridium-192 BT started on the day of the endoscopic incision or resection and continued for the following 3 days. The BT fractionation scheme was 4x3 Gy in the first three patients (until first relapse) and 4x4 Gy in all following patients. The dose was calculated at 3 mm tissue depth using 3-dimensional CT-planning. As of February 2004, the median follow-up of all patients reached 22 months. RESULTS Seven of 15 patients (46%) are recurrence free. In two patients (13.3%), recurrent strictures developed 12 month later, outside of the region of initial treatment. In six patients (40%) the treatment was considered to be unsuccessful as recurrent strictures were found between 2 and 12 months after the initial or second course of treatment. CONCLUSION Endourethral brachytherapy after endoscopic incision or resection is a promising treatment for the prevention of recurrent strictures of the urethra, bladder neck or vesicourethral anastomosis. The initial results have been very good, but with longer follow-up recurrence occurred in the irradiated area in 40% of patients. Prospective randomized studies in patients with a strictly defined type of recurrent stricture, or even after the first internal urethrotomy, should be done in the future.
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Affiliation(s)
- D Kröpfl
- Klinik für Urologie, Kinderurologie und urologische Onkologie, Ev. Huyssens-Stift gGmbH, Essen.
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Kamat N. Dynamic three-dimensional spiral computed tomographic cysto-urethrography: a novel technique for evaluating post-traumatic posterior urethral defects. BJU Int 2004; 94:191. [PMID: 15217462 DOI: 10.1111/j.1464-410x.2004.4949a.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Babnik Peskar D, Visnar Perovic A. Comparison of radiographic and sonographic urethrography for assessing urethral strictures. Eur Radiol 2003; 14:137-44. [PMID: 14504903 DOI: 10.1007/s00330-003-1929-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2002] [Revised: 02/04/2003] [Accepted: 04/01/2003] [Indexed: 12/29/2022]
Abstract
The aim of this study was to compare radiourethrography (RUG) and sonourethrography (SUG) for assessment of urethral strictures and to evaluate whether RUG underestimates stricture length, as has been reported. Fifty-one men with suspected urethral strictures were evaluated by both methods performed consecutively. Stricture lengths and diameters measured by RUG were significantly greater (mean 22%, 30%) than those measured by SUG because of radiographic magnification. Both methods, however, detected a similar percentage lumen reduction and similarly graded stricture severity. Equally significant non-correlation between both methods for length measurements in the bulbar and penile urethra ( p<0.001, R(2)=0.33 and 0.34, respectively) supported radiographic magnification. Previous inaccuracies appear to relate to RUG measurements of the central tight stricture (mean 44% of the entire length in our series), not the full stricture length. Use of sonographic contrast medium intra-urethrally improved the definition of long narrow strictures. The SUG gave information about peri-urethral tissues not provided by RUG. Once radiographic magnification was taken into account, there were no major differences in the assessment of urethral strictures by both methods. With correct measurement methods, RUG does not underestimate stricture length. For full assessment, the combination of RUG and SUG, which gives information about peri-urethral disease, is optimal in many patients.
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Affiliation(s)
- Darja Babnik Peskar
- Clinical Radiology Institute, University Medical Centre, Zaloska 7, 1000, Ljubljana, Slovenia.
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