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

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.

Female Urethral Disease: A Contemporary Review of Presentation, Diagnosis and Current Management Strategies

Background: Female urethral diseases are sparsely discussed within the literature when compared to urethral diseases affecting men. While, the male urethra is impacted more frequently secondary to the comparative increase in average length, presence of the prostate and considerations of carrying genetic material-disease process of the female urethra impose significant distress to affected patients and also potential for malignancy. The clinical presentation and management strategies often differs from the male counterpart and therefore it is important to consider disease processes of the female urethra unto their own right for evaluation and successful management. It is to that end this publication is put forth.

Aggressive course of a rare type of urethral cancer in women

The article provides a clinical case of urethral cancer in women. Primary urethral carcinomas are rare, less than 1% of all malignant tumors. According to the Rarecare Cancer Surveillance Agency for Europe (RARECARE), urethral cancer in women is 0.6 and 1.6 in men per 1 million people per year. A 56-year-old patient with histologically verified clear cell adenocarcinoma of the proximal urethra was monitored for 18 months. An aggressive course of the tumor process has been shown, which led to the need to perform anterior exenteration of the pelvic organs. The histogenesis of primary clear cell urethral adenocarcinoma has not been definitively determined. The atypical external localization in the described case suggests the periurethral origin of this cancerous tumor from the Skenes glands. The demonstration of a rare form of urethral cancer, clear cell adenocarcinoma, contributes to the accumulation of knowledge about its histopathology and clinical course, as well as increasing cancer alertness in the treatment of urethral diseases in doctors of any specialty.

Imaging of the adult male urethra, penile prostheses and artificial urinary sphincters

To discuss the imaging appearances of various pathologies affecting adult male urethra and to review the role of imaging in the assessment of artificial urinary sphincters and penile prostheses. Diagnosis of common male urethral diseases heavily depends on two conventional fluoroscopic techniques namely retrograde urethrography and voiding cystourethrography. These are useful in evaluating common urethral diseases like traumatic injury, infections, and strictures. Cross-sectional imaging can be useful in evaluating periurethral pathologies. Artificial urinary sphincters, slings, and periurethral bulking agents are used in the management of urinary incontinence and imaging can be utilized to detect complications in these devices. Cross-sectional imaging especially MRI plays a significant role in evaluating the different types of penile prostheses and their malfunctioning.

Urological pathology

This chapter discusses urological pathology and covers diseases of the urinary tract managed by urologists. This includes genitourinary malformations, urinary tract infection, urinary tract obstruction, urinary calculi, cystic renal diseases, benign renal tumours, renal cell carcinoma (RCC), childhood renal tumours, urothelial carcinoma, benign prostatic hyperplasia (BPH), prostate carcinoma, testicular germ cell tumours, testicular non-germ cell tumours, paratesticular diseases, urethral diseases, penile diseases, and scrotal diseases.

Multiple urethral calculus misdiagnosed as urethral stricture: The role of imaging in unknotting the confusion

Urinary Tract Calculi Impaction / finding in the male urethra is extremely uncommon and can usually be secondary to upper urinary tract calculus formation or primarily arising from the urethra either due to stricture or post-trauma. There is paucity of urethral stricture report in Nigeria, thus this case is reported to highlight the role of imaging in the prompt diagnosis and management of urethral diseases; and to advise urologists to at least always request for imaging modality in their routine evaluation of urethral pathologies. We report a case of a 55 years old male farmer who presented in the Accident and Emergency Unit of our facility with signs and symptoms of acute urinary retention. A working diagnosis of urethral stricture was entertained and prompt diagnosis was made on image. Existing literatures outlining the pathologies, clinical presentation, therapeutic consideration and imaging as it relates to urethral calculi were reviewed. We thus concluded that imaging is very vital and fundamental in order to correctly assess any form of urethral pathology.Asian Journal of Medical Sciences Vol. 7(3) 2016 118-120