The Role of Urethrography in Urethral Disease. Part II. Indications for Transphincter Urethroplasty In Patients With Primary Bulbous Strictures

Abstract

We herein outline the radiological and clinical criteria that will aid the surgeon in deciding whether transphincter urethroplasty is required in patients whose primary stricture is in the proximal bulbous urethra. Since proximal bulbous urethral strictures are common the urologist frequently is called upon to make this important decision. The criteria described herein will help him to do so and, thus, avoid urethroplasty failure because of proximal stenosis in the membranous urethra. The concept of paradoxical dilatation of the membranous urethra on voiding urethrography also is described. Paradoxical dilatation means that in the presence of a primary obstructive bulbous urethral stricture the membranous urethra, although containing significant scar tissue, is dilated on the voiding study because of the distal obstruction. Relief of the bulbous urethral stricture alone may result in rapid contraction and stenosis of the previously dilated membranous urethra.