PD35-07 DYNAMIC MRI URETHROGRAM: A NEW FRONTIER IN URETHRAL STRICTURE EVALUATION

Abstract

You have accessJournal of UrologyCME1 Apr 2023PD35-07 DYNAMIC MRI URETHROGRAM: A NEW FRONTIER IN URETHRAL STRICTURE EVALUATION André Cavalcanti, Rafael Cobo, Gabriel Affonso, and Felipe Da Silva André CavalcantiAndré Cavalcanti More articles by this author , Rafael CoboRafael Cobo More articles by this author , Gabriel AffonsoGabriel Affonso More articles by this author , and Felipe Da SilvaFelipe Da Silva More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003333.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The urethral stricture is a disease that cause severe impact on the quality of life in male patients. As a disease were the definitive treatment is a surgical procedure, an adequate pre-operative image study for the surgical planning is essencial. The Retrograde Urethrogram has been the gold standard method for the urethral stricture evaluation during the paste decades. This method has limitations as technical points associated to failures to a precise measure of the stricture length/localization and the incapacity to evaluate the peri-urethral fibrosis. The objective of this study is to test the Dynamic MRI Urethrogram as a unique method to urethral stricture diagnostic and pre-operative evaluation. METHODS: A Group of 25 consecutive patients with a suspicion of urethral stricture disease were submitted to a Dynamic MRI Urethrogram as the unique image study to confirm the diagnosis, disease characterization and surgical planning. All patients were submitted to the same MRI protocol: peripheral venous access and hydration with at least 500 ml of saline solution to stimulate diuresis, installation of 20 ml to 40 ml of lidocaine gel through the meatus, noosing the balanoprepucial sulcus with a sterile gauze. After, routine sequences were performed: Axial T1w, Axial and Sagittal T2, SPACE coronal, MIP Sagittal, T2 Urographic effects techniques images obtained during rest and miccional strain, T1 FS Sagittal before and after gadolinium. All patients were submitted to a urethral reconstruction performed by the same surgeon: anastomotic urethroplasty in 16 patients (64%) and substitution urethroplasty with buccal mucosa graft in 9 patients (36%). RESULTS: In The Dynamic MRI Urethrogram was considered adequate for the definition of surgical proposal in all patients. A diagnostic of anterior urethra strictures was observed in 12 patients (48%) and posterior urethra strictures in 13 patients (53%). The surgeon observed a correspondence between MRI images and surgical findings regarding the location and length of the stricture in all patients. The Dynamic MRI Urethrogram was also adequate to evaluate the urethral caliber in the site of the stricture and the peri-urethral fibrosis. An advantage observed with the use of this method was the possibility to evaluate other organs, structures and the relation with the urethra and the stricture area as rectum, prostate and pubis. The Dynamic MRI Urethrogram also gives the possibility of 3 D reconstructions. CONCLUSIONS: The Dynamic MRI Urethrogram is an excellent method to evaluate the urethral stricture in different portions such anterior and posterior urethra with possible advantages over other methods as the precision measure of location, length, caliber and also evaluation of peri-urethral fibrose and relation with other organ and structures. All those characteristics are important to the surgical planning, specially using a unique image method. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e977 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information André Cavalcanti More articles by this author Rafael Cobo More articles by this author Gabriel Affonso More articles by this author Felipe Da Silva More articles by this author Expand All Advertisement PDF downloadLoading ...