Diagnosis of Urethral Stricture on Dynamic Voiding Transvaginal Sonourethrography

Abstract

Urethral stricture in a woman is a difficult diagnosis to establish due to its rarity and clinical resemblance to bladder outlet obstruction. Imaging is used to differentiate between the various bladder, urethral, and extrinsic causes of obstruction with the standard voiding cystourethrographic examination but with little success in female patients. The following case presents complete urethral stricture in a woman, which was detected with transvaginal sonography. Transvaginal sonography is not a common modality used to assess female urethral anatomy. The urinary bladder is comfortably distended, unlike in transvaginal sonography for gynecologic indications. Urethral evaluations can be carried out while the patient strains in an attempt to void the urinary bladder. As the normal proximal urethra distends with the antegrade flow of urine during straining, the urethral caliber and wall can be evaluated to assess the level, cause, and severity of obstruction. Sonography provides the unique ability to capture a dynamic assessment of the urethra for a reasonable length of time, without the use of ionizing radiation.