Validation of the role of retrograde urethrogram in the management of urethral strictures

Abstract

Introduction: Urethral stricture is a common cause of lower urinary tract symptoms in the middle aged and elderly men in our environment. Its diagnosis and management is hinged mainly on a retrograde urethrogram (RUG) that is associated with variable lengths and sites with that found intraoperatively due to difference in magnification (source patient as well as source image distance), penile stretch, and positioning during the procedure. We hereby sort to validate this tool in defining urethral strictures. Materials and Methods: Adult patients with lower urinary tract symptoms suspected to be due to urethral strictures who presented to the outpatient department and emergency departments of the hospital between January 2016 to December 2016 were recruited into the study. This was followed by obtaining an informed consent from the patient and ethical clearance from the institution. Patients who were not fit or not willing to have a urethroplasty were excluded from the study. The recruited patients had RUG to characterize the strictures. The intraoperative findings at urethroplasty were compared with that found on RUG. Data were collected and analyzed using SPSS version 23 to determine sensitivity specificity of the test. Results: A total of 84 patients were studied during the period. The mean age of the patients was 44.1 years. Bulbar strictures accounted for 65% of the strictures. Most of the strictures were single (72%) and long segment (52%). Sensitivity and specificity of RUG in determination of the length of stricture were 76.9% and 74.6%, respectively, whereas the sensitivity and specificity of RUG in determination of site of stricture were 92.9% and 96.4%, respectively. The determination of number of stricture on RUG has a sensitivity of 94.2% and specificity of 90.8%. Conclusion: RUG is a valuable tool in the management of urethral strictures with a higher sensitivity and specificity for the determination of site and number of strictures as compared to length of stricture that is more affected by magnification and techniques in contrast administration. This should be considered during procedure as well as during interpretation of images.