ObjectiveManagement of urethral stricture disease depends on the location, length of stricture, and associated urethral pathology. These parameters are obtained from preoperative imaging, with conventional urethrogram (retrograde urethrogram and micturating cystourethrogram [RGU/MCU]) being the diagnostic tool of choice despite its many shortcomings. Sono-urethrogram (SUG) is an alternative which addresses most issues of RGU/MCU. Studies comparing RGU/MCU with SUG are limited. With objective of comparing these two imaging modalities in the evaluation of urethral stricture disease, a prospective study was conducted. MethodsFifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in study. SUG was performed by the experienced consultant radiologist who was blinded to the report of RGU/MCU. Findings of RGU/MCU and SUG were compared to intra-operative findings which served as the reference standard. ResultsThe median length of strictures determined intraoperatively was 16.50 mm, by RGU/MCU was 5.85 mm, and by SUG was 13.50 mm. Diagnostic accuracy for determination of stricture location was 93.45% for RGU/MCU and 98.28% for SUG. SUG identified spongiofibrosis in 90.00% of patients with higher accuracy for severe degree of fibrosis. ConclusionsSUG has shown to be more accurate than RGU/MCU for estimation of stricture length and location with added advantage of evaluating spongiofibrosis. Use of SUG in conjunction to RGU/MCU helps in better guidance of stricture management by improving preoperative assessment. Further studies with larger sample size are warranted.