Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures. Should the novel methods become the new standard in radiological diagnosis of urethral stricture disease?

Abstract Purpose To verify which of the diagnostic modalities: Voiding cystouretrography (VCUG), Sonouretrography (SUG) or Magnetic resonance uretrography (MRU) is the most accurate in the assessment of urethral strictures in males and in what cases the application of novel imaging techniques benefits most. Methods 55 male patients with a diagnosis of urethral stricture, were enrolled in this prospective study. Initial diagnosis of urethral stricture was based on anamnesis, uroflowmetry and VCUG. Additional imaging procedures—SUG and MRU were performed before the surgery. Virtual models and 3D printed models of the urethra with the stricture were created based on the MRU data. Exact stricture length and location were evaluated by each radiological method and accuracy was verified intraoperatively. Agreement between SUG and MRU assessments of spongiofibrosis was evaluated. MRU images were independently interpreted by two radiologists (MRU 1, MRU 2) and rater reliability was calculated. Results MRU was the most accurate [(95% CI 0.786–0.882), p < 0.0005] with an average overestimation of 1.145 mm (MRU 1) and 0.727 mm (MRU 2) as compared with the operative measure. VCUG was less accurate [(95% CI 0.536–0.769), p < 0.0005] with an average underestimation of 1.509 mm as compared with operative measure. SUG was the least accurate method [(95% CI 0.510–0.776), p < 0.0005] with an average overestimation of 2.127 mm as compared with the operative measure. There was almost perfect agreement of MRU interpretations between the radiologists. Conclusions VCUG is still considered as a ‘gold standard’ in diagnosing urethral stricture disease despite its limitations. SUG and MRU provide extra guidance in preoperative planning and should be considered as supplemental for diagnosing urethral stricture. Combination of VCUG and SUG may be an optimal set of radiological tools for diagnosing patients with urethral strictures located in the penile urethra. MRU is the most accurate method and should particularly be considered in cases of post-traumatic or multiple strictures and strictures located in the posterior urethra.

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Letter to the editor re: Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures: should the novel methods become the new standard in radiological diagnosis of urethral stricture disease? Mikolaj et al., IJUN (October 2021)

International Urology and Nephrology ◽

10.1007/s11255-021-03090-4 ◽

2022 ◽

Author(s):

Daniel P. McNicholas ◽

Ahmad M. Omar ◽

Rauf N. Khadr ◽

Michael S. Floyd

Keyword(s):

Magnetic Resonance ◽

Urethral Stricture ◽

Radiological Diagnosis ◽

The Novel ◽

Urethral Stricture Disease ◽

Urethral Strictures ◽

Letter To The Editor ◽

Retrograde Urethrography ◽

Novel Methods

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Outcome of urethral strictures treated by endoscopic urethrotomy and urethroplasty

Canadian Urological Association Journal ◽

10.5489/cuaj.1407 ◽

2014 ◽

Vol 8 (1-2) ◽

pp. 16 ◽

Cited By ~ 6

Author(s):

Javier Tinaut-Ranera ◽

Miguel Angel Arrabal-Polo ◽

Sergio Merino-Salas ◽

Mercedes Nogueras-Ocaña ◽

Victor Lopez-Leon ◽

...

Keyword(s):

Surgical Treatment ◽

Urethral Stricture ◽

Previous Treatment ◽

Urinary Flow ◽

The Past ◽

Urethral Strictures ◽

High Surgical Risk ◽

Endoscopic Urethrotomy ◽

Male Patients ◽

Maximum Urinary Flow

Introduction: We analyze the outcomes of patients with urethral stricture who underwent surgical treatment within the past 5 years.Methods: This is a retrospective study of male patients who underwent surgery for urethral stricture at our service from January 2008 to June 2012. We analyzed the comorbidities, type, length and location of the stricture and the surgical treatment outcome after endoscopic urethrotomy, urethroplasty or both.Results: In total, 45 patients with a mean age of 53.7 ± 16.7 years underwent surgical treatment for urethral stricture. Six months after surgery, 46.7% of the patients had a maximum urinary flow greater than 15 mL/s, whereas 87.3% of the patients exhibited no stricture by urethrography after the treatment. The success rate in the patients undergoing urethrotomy was 47.8% versus 86.4% in those undergoing urethroplasty (p = 0.01). Twenty percent of the patients in whom the initial urethrotomy had failed subsequently underwent urethroplasty, thereby increasing the treatment success.Conclusion: In most cases, the treatment of choice for urethral stricture should be urethroplasty. Previous treatment with urethrotomy does not appear to produce adverse effects that affect the outcome of a urethroplasty if urethrotomy failed, so urethrotomy may be indicated in patients with short strictures or in patients at high surgical risk.

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Urethral strictures

10.1093/med/9780199659579.003.0050 ◽

2017 ◽

Author(s):

Anthony R. Mundy ◽

Daniela E. Andrich

Keyword(s):

Urethral Stricture ◽

Daily Basis ◽

Current Approach ◽

Curative Treatment ◽

Urethral Stricture Disease ◽

Urethral Strictures ◽

History Of ◽

The Subject ◽

Ambivalent Attitude ◽

Almost All

Urethral strictures are common and almost all urologists will deal with them on a regular if not daily basis. They have always been common and the history of the subject stretches back to 3,000 BC. Urethral dilators have been found in the tombs of the pharaohs so that they might be able to catheterize themselves or dilate their own strictures in the afterlife. Urethrotomy and dilatation are two of the most frequently performed procedures in urology. But these are usually only palliative, and curative treatment by urethroplasty is performed by very few urologists. In part this is because most strictures are bulbar strictures and most non-bulbar strictures are seen only by reconstructive urologists; but in part this represents a somewhat ambivalent attitude of most urologists to urethral stricture disease. In this chapter, we will attempt to clarify the current approach to this problem.

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MAGNETIC RESONANCE URETHROGRAPHY VERSUS RETROGRADE URETHROGRAPHY IN THE EVALUATION OF ANTERIOR URETHRAL STRICTURE DISEASE: A PROSPECTIVE STUDY

The Journal of Urology ◽

10.1016/s0022-5347(08)61994-1 ◽

2008 ◽

Vol 179 (4S) ◽

pp. 682-683

Author(s):

Mohammed Elgammal ◽

Ayman Mahdy ◽

Hisham Imam ◽

Hisham Hammouda ◽

Ahmed Abdel-Moneim ◽

...

Keyword(s):

Magnetic Resonance ◽

Prospective Study ◽

Urethral Stricture ◽

Urethral Stricture Disease ◽

Retrograde Urethrography ◽

A Prospective Study

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Clinical features of spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy

Experimental and Сlinical Urology ◽

10.29188/2222-8543-2021-14-3-156-163 ◽

2021 ◽

Vol 14 (3) ◽

pp. 156-163

Author(s):

V.P. Glukhov ◽

◽

A.V. Ilyash ◽

V.V. Mitusov ◽

D.V. Sizyakin ◽

...

Keyword(s):

Clinical Features ◽

Urethral Stricture ◽

Inclusion Criteria ◽

Exclusion Criteria ◽

Urethral Stricture Disease ◽

One Stage ◽

Urethral Strictures ◽

Multi Stage ◽

History Of ◽

Urethral Surgery

Introduction. Extended spongy urethral strictures require the use of plastic surgery techniques. In most cases, a one-stage urethral repair can be performed. However, staged urethroplasty and permanent urethrostomy are important in patients with extremely complex urethral strictures. Purpose of the study. To determine the clinical features of spongy urethral strictures, which cannot be cured by one-stage urethroplasty, but are subject to multistage plastic or permanent urethrostomy. Materials and methods. The study included 158 patients who underwent surgery for urethral strictures in 2010 − 2019. Inclusion criteria: spongy urethral strictures requiring staged urethroplasty or permanent urethrostomy. Exclusion criteria: age<18 years, proximal urethral strictures, urethra-vesical anastomosis and bladder neck stenosis, previously untreated congenital anomalies (hypospadias and epispadias), and history of any other urethral surgery not meeting the inclusion criteria. Results. The age of the patients ranged from 18 to 88 years. Iatrogenic (34.8%) and inflammatory (32.3%) urethral lesions predominate in the structure of etiological factors with the most common penile localization of narrowing (43.7%). The length of strictures in half of the patients exceeds 6 cm; a quarter of the sample has subtotal and total spongy urethral lesions. The proportion of recurrent urethral strictures is 56.3%. The average duration of the urethral stricture disease reaches 8 years. In 61.3% of cases, the disease is accompanied by complications from both local tissues and organs of the urinary and reproductive systems. Conclusion. Clinical evaluation of patients with spongy urethral strictures requiring multi-stage urethroplasty or permanent urethrostomy reveals a particular severity of urethral stricture disease. This category of patients has a high risk of unsuccessful outcomes with one-stage surgery. In these cases, patients require a multi-staged urethroplasty or a permanent urethrostomy.

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Penile urethral stricture disease

Journal of Clinical Urology ◽

10.1177/2051415818774227 ◽

2018 ◽

Vol 12 (2) ◽

pp. 145-157

Author(s):

Marco Spilotros ◽

Suzie Venn ◽

Paul Anderson ◽

Tamsin Greenwell

Keyword(s):

Urethral Stricture ◽

Lichen Sclerosus ◽

Corpus Spongiosum ◽

Hypospadias Repair ◽

Internal Urethrotomy ◽

Level Of Evidence ◽

Urethral Stricture Disease ◽

Urethral Strictures ◽

Considerable Cost ◽

The Uk

Patients affected by a urethral stricture account for a considerable cost to all healthcare systems. The estimated prevalence of all urethral stricture in the UK is 10/100,000 men during youth, increasing to about 40/100,000 by age 65 years and to more than 100/100,000 thereafter. A penile urethral stricture is a narrowing of the lumen of the urethra due to ischaemic fibrosis of the urethral epithelium and/or spongiofibrosis of the corpus spongiosum occurring within the penile urethra. Its aetiology is largely idiopathic but other important causes are failed hypospadias repair and lichen sclerosus, which account for 60% of all cases. Strictures of the anterior urethra account for 92% of cases: bulbar strictures are more frequent (46.9%), followed by penile (30.5%) and combined bulbar/penile (9.9%), that is, 40.4% of all men presenting with stricture will have a penile urethral stricture alone or in combination with a bulbar urethral stricture. There are several options for the treatment of penile urethral strictures ranging from less invasive treatments, including urethral dilatation and direct vision internal urethrotomy, to more complex augmentation graft and flap urethroplasty. The aim of the present review is to describe the aetiology and epidemiology of anterior urethral strictures and the available options reported in literature for their treatment. Level of evidence: 1a

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Recent Advances in treatment of urethral stricture disease in men

F1000Research ◽

10.12688/f1000research.21957.1 ◽

2020 ◽

Vol 9 ◽

pp. 330

Author(s):

Naside Mangir ◽

Christopher Chapple

Keyword(s):

Tissue Engineering ◽

Regenerative Medicine ◽

Urethral Stricture ◽

Treatment Options ◽

Internal Urethrotomy ◽

Engineering Research ◽

Urethral Stricture Disease ◽

Urethral Strictures ◽

Main Challenge ◽

Tissue Engineering Research

Urethral stricturing is a narrowing of the urethral lumen as a result of ischaemic spongiofibrosis. The main challenge of currently available treatment options is recurrence of the stricture. Recent advancements in the treatment of urethral strictures mainly came from the fields of regenerative medicine and tissue engineering. Research efforts have primarily focused on decreasing the recurrence of stricture after internal urethrotomy and constructing tissue-engineered urethral substitutes to improve clinical outcomes of urethroplasty surgeries. The aim of this article is to review the most recent advancements in the management of urethral stricture disease in men.

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Have our strictures changed? Analysis of Current Characteristics and Management of Urethral Stricture Disease in Zaria, Nigeria

10.21203/rs.2.14252/v1 ◽

2019 ◽

Author(s):

Nasir Oyelowo ◽

Muhammed Ahmed ◽

Ahmad Bello ◽

Ahmad Tijani Lawal ◽

Husseni Yusuf Maitama ◽

...

Keyword(s):

Urethral Stricture ◽

Tertiary Hospital ◽

Study Data ◽

Pedicled Flap ◽

Urethral Stricture Disease ◽

Urethral Strictures ◽

Buccal Mucosa Graft ◽

Geographical Regions ◽

Post Traumatic ◽

Current Characteristics

Abstract Introduction: Urethral stricture is a common cause of lower urinary tract symptoms in the middle aged and elderly men. Its presentation and management is closely linked with its etiology and this varies across geographical regions of the world as well as over time. We hereby review the etiology, characteristics and presentation of men with urethral strictures in a tertiary hospital in northern Nigeria over a year and compare it with previous studies in the region. Patients and Methods The study was a prospective study from January-December 2016, all patients with urethral strictures and who consented to the study were enrolled into the study. Data was collected using a structured study profoma and analyzed using SPSS version 23. Results The mean age was 44.1 years with a range of 13-71 years. The bulbar urethra was the site of most strictures with a frequency of 65%. The etiology was infection in majority of the patients with a frequency of 53.3%. Post traumatic strictures occurred in 33.3% while iatrogenic and catheter –Induced strictures were seen in 7.1% and 6% respectively. 88% had no previous intervention for the stricture prior to presentation.The complications from urethral strictures observed in the patients were acute urinary retention in 83.4% urethrocutaneous fistulae in 2.4% and urosepsis in 1.2% of the patients. 11% presented with no complication.68% of these patients were managed by excision and end to end anastomosis, 15 % had a penile pedicled flap 12% , a buccal mucosa graft urethroplasty and 5% with staged urethroplasty The trends in etiology of urethral stricture disease in the region reported is: Ahmed etal in zaria (1990) Infection accounted for 66.50% , post traumatic stricture 31.50%. Ntia et al Sokoto (2006)found infection as aetiology in 44.70% and post-traumatic strictures in 47.40%. Ofoha et al in Jos however found Infection in 53.30% and post traumatic 40.30% Conclusion Though there is a gradual rise in post-traumatic and iatrogenic strictures in our environment, Post inflammatory strictures still predominates. It is however infrequently accompanied by fistulae as seen decades ago. These strictures are mostly long segments single bulbar strictures

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A Multimodality Review of Male Urethral Imaging: Pearls and Pitfalls with an Update on Urethral Stricture Treatment

British Journal of Radiology ◽

10.1259/bjr.20211034 ◽

2022 ◽

Author(s):

Jonathan Wesley Revels ◽

Sherry S Wang ◽

Jennifer S Weaver ◽

Jordan R Foreman ◽

Maxx A Gallegos ◽

...

Keyword(s):

Magnetic Resonance ◽

Ionizing Radiation ◽

Imaging Techniques ◽

Clinical Scenario ◽

Radiological Assessment ◽

Male Urethra ◽

Adjacent Tissue ◽

Urethral Strictures ◽

Operative Evaluation ◽

Urethral Diseases

Optimum radiological assessment of the male urethra requires knowledge of the normal urethral anatomy and ideal imaging techniques based on the specific clinical scenario. Retrograde urethrography is the workhorse examination for male urethral imaging, usually utilized as the initial, and often solitary, modality of choice not only in the setting of trauma, but also in the pre- and post-operative evaluation of urethral strictures. There is, however, growing interest in utilization of ultrasound and magnetic resonance for evaluation of the male urethra owing to lack of ionizing radiation and improved delineation of the adjacent tissue. We review the various modalities utilized for imaging of the male urethra for a variety of known or suspected disorders, and provide an update on current treatments of urethral strictures. Additionally, we detail the key information needed by urologists to guide management of urethral strictures. We conclude with a brief discussion of neophallus urethral diseases following female-to-male sexual confirmation surgery.

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