Retrograde sagittal urethrography in diagnostics of urethral stricture disease: shifting the focus

Abstract

Background. For over a century retrograde urethrography (RUG) has offered the key method to diagnose urethral stricture (US). The disadvantage of the technique, however, is a potential high risk to underestimate the stricture length due to distorted visualization and eventual flawed surgical planning.Aim. To consider retrograde sagittal urethrography (RSU) and how it contributes to enhancing US preoperative diagnostics and treatment efficacy in clinical practice.Materials and methods. We compared the protocols of pre-op urethrograms performed by a radiologist and a urologist to surgery protocols for both patient groups. Group 1 included 154 patients who underwent US surgical treatment from 2017 to 2021 after using RSU as a diagnostic method (positioning 90°). Group 2 comprised 142 patients presented with identical disease who received surgery between 2012 to 2016 in our hospital after RUG using traditional technique (positioning 45°). Discrepancies of 5 mm and over in stricture length measurements between radiography protocols and intraoperative data were considered a diagnostic flaw (i.e. inconsistency). Treatment efficacy was compared across both groups.Results. In 87.6 % of cases in Group 1 (RSU) protocols provided by a radiologist matched intraoperative data versus45.7 % of cases receiving accurate protocol data in Group 2 (RUG) (χ2 = 59.15, p <0.001). Urethrogram protocols prepared by a urologist pre-operatively were accurate in 95.4 % of cases in Group 1 versus 62.0 % in Group 2 (χ2 = 49.11, p <0.001). The overall efficiency of surgery was higher in Group 1 (91.6 %), than in Group 2 (82.4 %) (χ2 = 5.54, p <0.01).Conclusion. RSU is an innovative technique that allows to significantly improve the accuracy of urethral stricture length measurement, resulting in greater treatment efficiency in Group 1 of patients. The proposed urethrographic technique can be recommended as a basic diagnostic procedure for anterior US in men.