Conventional Urethrography Research Articles

Comparative study of sonourethrography and conventional urethrography in determining the length of anterior urethral strictures

Background: Conventional urethrography has been the “Gold standard” in the evaluation of anterior urethral strictures. Sonourethrography (SUG) is less invasive, more readily available, and cheaper and does not use ionizing radiation.
 Objective: To determine the length of anterior urethral strictures diagnosed on conventional urethrography using SUG and compare findings on SUG with conventional urethrography in adult male patients
 Methodology: This was a prospective cross-sectional study carried out over a period of twelve months, whereby 66 male patients with clinically suspected anterior urethral strictures and confirmed on retrograde urethrography (RUG)/ Micturatingcystourethrography (MCUG) were examined using SUG. The length of anterior urethral strictures from both procedures were compared. The data analysis was done using statistical package for social sciences (SPSS) version 23(SPSS Inc, IL, USA). At 95% confidence interval, P-value ≤ 0.05 was considered statistically significant.
 Result: Sixty six patients were studied. The mean age of the participants was 56.7±13.7years with an age range of 20 – 78 years. The stricture lengths and diameters were consistently higher on SUG compared to conventional urethrography. The mean length of stricture on RUG/MCUG and SUG were 19.4 ± 6.0mm and 21.3± 6.7 mm respectfully. The mean difference for the stricture lengths on RUG/MCUG and SUG was 1.9 mm and this was statistically significant (CI = 0.983 – 2.761, p < 0.001). The mean diameter of the stricture on RUG/MCUG and SUG were 2.2± 0.7mm and 5.6± 1.2mm and the mean difference for the stricture diameter on both techniques was 3.4mm (CI= 3.158 – 3.577, p<0.001), which was statistically significant.
 Conclusion: Significantly higher mean stricture length and diameter were found on SUG compared with RUG/MCUG.

Role of MR urethrography in detection and characterization of various urethral lesions in male patients and its comparison with conventional urethrography and Sonourethrography

Role of MR urethrography in detection and characterization of various urethral lesions in male patients and its comparison with conventional urethrography and Sonourethrography

Multimodality imaging of the male urethra: trauma, infection, neoplasm, and common surgical repairs.

The aim of this article is to describe the indications and proper technique for RUG and MRI, their respective image findings in various disease states, and the common surgical techniques and imaging strategies employed for stricture correction. Because of its length and passage through numerous anatomic structures, the adult male urethra can undergo a wide array of acquired maladies, including traumatic injury, infection, and neoplasm. For the urologist, imaging plays a crucial role in the diagnosis of these conditions, as well as complications such as stricture and fistula formation. While retrograde urethrography (RUG) and voiding cystourethrography (VCUG) have traditionally been the cornerstone of urethral imaging, MRI has become a useful adjunct particularly for the staging of suspected urethral neoplasm, visualization of complex posterior urethral fistulas, and problem solving for indeterminate findings at RUG. Familiarity with common urethral pathology, as well as its appearance on conventional urethrography and MRI, is crucial for the radiologist in order to guide the treating urologist in patient management.

Pubourethral Stump Angle Measured on Preoperative Magnetic Resonance Imaging Predicts Urethroplasty Type for Pelvic Fracture Urethral Injury Repair

To examine whether the type of delayed urethroplasty required for pelvic fracture urethral injury, which is not easily predicted from conventional urethrography findings, can be predicted from preoperative magnetic resonance imaging (MRI) results. Records of 74 male patients with pelvic fracture urethral injury who underwent MRI of the pelvis at least 3 months after injury and, subsequently, delayed anastomotic urethroplasty were retrospectively analyzed. Pubourethral stump length (PUL) was defined as the distance between the distal end of the proximal urethral stump and the lower border of the inferior pubic ramus. Pubourethral stump angle (PUA) was defined as the angle between the long axis of the pubis and the line between the distal end of the proximal urethral stump and the lower border of the inferior pubic ramus. Both PUL and PUA were measured in sagittal T2-weighted MRI. Delayed urethroplasty was performed by a simple perineal approach in the 28 patients requiring only bulbar urethral mobilization with or without corporal splitting and by elaborate approach in the 46 additionally requiring inferior pubectomy or an abdominoperineal approach with urethral rerouting. The overall success rate defined as no recurrent stricture on urethroscopy was 94.6%. Disruption at the prostate apex, greater urethral gap length, longer PUL, and lower PUA were in univariate analysis significantly associated with an elaborate approach. In multivariate analysis, only low PUA was an independent predictor of the need for an elaborate approach. PUA measured on MRI is useful for predicting the type of reconstruction needed for urethral repair.

Role of MR urethrography in assessment of urethral lesions

Aim of the workTo evaluate the utility of magnetic resonance (MR) urethrogram in the diagnosis and characterization of different urethral lesions in comparison with conventional urethrography. Material and methodsThis prospective study included 18 male patients diagnosed to have urethral lesions. All of these patients were evaluated by using conventional urethrography prior to MR imaging. MR urethrography technique included: thick slab fast spin echo T2 (TSFSE) and fast recovery fast spin echo (FRFSE). ResultsThe causes of urethral lesions were: trauma in 13 patients (affecting the anterior urethra in 5 patients, the posterior urethra in 7 patients, the anterior and posterior urethra in one patient).Congenital abnormality in 3 patients at the anterior urethra and infection at the anterior urethra in 2 patients.Conventional urethrography and MRI diagnosed the presence of urethral pathology in all examined patients, However MR urethrography was superior in better delineation and characterization of the urethral pathology in four cases (22.2%) diagnosing prostatic displacement as well as periurethral fibrosis. Conventional urethrography was superior to MR urethrogram in diagnosing a case of diffuse pseudodiverticulosis. ConclusionMR urethrography is a suitable technique for the evaluation of urethral and periurethral abnormalities.

English

BACKGROUND: Previously retrograde urethrography and micturating cystoure- thrography were used for the evaluation of urethral strictures. Lack of radiation, ability to assess of mucosal and periurethral abnormality and more precise measurement of stricture length makes the sonourethrography an alternative to conventional urethrography. In this article we had reported our experience regarding sonourethrography in cases of anterior urethral strictures. OBJECTIVES: Role of sonourethrography in evaluation of anterior urethral abnormalities (especially strictures), Staging and grading of anterior urethral strictures. To compare the utility of sonourethrography as compared to conventional retrograde urography. Role of sonourethrography in diagnosis, management and follow-up of anterior urethral disorders (especially strictures). MATERIAL AND METHOD: 70 male patients with obstructive urinary symptoms reffered from urology department for retrograde urethrography were selected. Sonourethrographic studies were performed using high frequency probe while injecting saline solution through 12 F Foley's catheter with bulb inflated in the fossa navicularis. Findings were compared with retrograde urethrography and urethroscopy. RESULT: Out of total 70 patients who underwent sonourethrogram, 33 patients were diagnosed to have 39 strictures. Out of these 39 strictures, 2 strictures were mild (5.12%), 16 were moderate (41.02%) and 21 were severe (53.84%). 20 strictures were short (focal) while 13 were long (diffuse). One patient had 3 large urethral calculi within the urethral lumen area which were visualised on sonourethrogram. These 39 strictures were also classified under five grade classification proposed by Chiou et al. Of these 39 strictures, 2 classified as GRADE I (5.12%), 6 classified as GRADE II (15.38%), 11 classified as GRADE III (28.20%), 4 classified as GRADE IV (10.25%), 16 came under GRADE V (41.02%). CONCLUSION: Sonourethrography can be used as an alternative to retrograde urethrography in the diagnosis of urethral disorder, characterization of urethral strictures and

Can Computed Tomography--assisted Virtual Endoscopy Be an Innovative Tool for Detecting Urethral Tissue Pathologies?

To test if virtual endoscopy (VE) enabled by 3-dimensional computed tomographic (CT) scanner with supporting software allows for practical clinical interrogation and evaluation of the urethral lumen and anatomy in an animal model. Assessment of urethral anatomy and repair results was performed in 18 male beagles using conventional retrograde urethrography, CT-assisted retrograde urethography, and voiding urethrocystography. The image slices from these studies were processed using TeraRecon software to create a virtual representation of the urethra and compared with conventional urethrography and postmortem analysis of retrieved urethras for diagnostic assessment and correlation. CT-assisted VE showed the orientation, size, and gross morphology of urethral anatomy, including the lesions in all the 18 animals studied. The VE showed patent urethra in 12 dogs, stenosed urethra in 3 dogs, urethral diverticulum with stricture in 2 animals, and fistula in one. These findings correlated with those of conventional diagnostic methods. The findings of the voiding and retrograde virtual urethrocystoscopy studies were also comparable. These results demonstrate that CT-assisted VE is able to identify the anatomic landmarks in an animal model. This allows for detection of the site of different pathologies and their relations to important structures such as urethral sphincters and the bladder neck. Digital imaging might be used to identify urethral pathologies with greater details and characterization of the lesions when compared with the conventional urethrocystography.

Three-dimensional spiral computed tomographic cysto-urethrography for post-traumatic complex posterior urethral strictures associated with urethral-rectal fistula

To evaluate the value of three-dimensional spiral computed tomography/cysto-urethrography (CTCUG) in diagnosing posterior urethral strictures associated with urethrorectal fistulas (URF). Between June 2008 and March 2012, 38 patients with posterior urethral strictures associated with URFs were examined by CTCUG, retrograde urethrography (RUG) and cysto-urethrography (CUG). Urethral reconstruction was undertaken and URFs were surgically repaired in all patients. The length of the urethral defect, location and size of URFs were recorded. Data from radiological examinations were compared with surgical findings. No statistically significant difference was found in the length of stricture measured using CTCUG (4.31 ± 2.28 cm) or conventional urethrography (4.02 ± 3.12 cm; p > 0.05), However, the accuracy in determining the location of the stricture was higher with CTCUG (93.12%) than with conventional urethrography (70.59%; p < 0.05). CTCUG identified URFs in all 38 patients (100%), whereas URFs were only observed in 27 patients (71%) using conventional urethrography. In conclusion, CTCUG was more accurate, safer and provided more details of URFs and urethral defects than conventional urethrography in patients with posterior urethral strictures associated with URFs.

MRI of the penis

MRI of the penis is an expensive test that is not always superior to clinical examination or ultrasound. However, it shows many of the important structures, and in particular the combination of tumescence from intracavernosal alprostadil, and high-resolution T(2) sequences show the glans, corpora and the tunica albuginea well. In this paper we summarise the radiological anatomy and discuss the indications for MRI. For penile cancer, it may be useful in cases where the local stage is not apparent clinically. In priapism, it is an emerging technique for assessing corporal viability, and in fracture it can in most cases make the diagnosis and locate the injury. In some cases of penile fibrosis and Peyronie's disease, it may aid surgical planning, and in complex pelvic fracture may replace or augment conventional urethrography. It is an excellent investigation for the malfunctioning penile prosthesis.

Flexible Cystoscope for Evaluating Pelvic Fracture Urethral Distraction Defects

Objective: To describe the value of flexible cystoscopy versus conventional urethrography (retrograde urethrography and cystourethrography) in diagnosing pelvic fracture urethral distraction defects (PFUDDs). Patients and Methods: Between May 2010 and June 2011, 120 male patients with PFUDDs were evaluated. In this study, all patients underwent conventional urethrography after admission. Flexible cystoscopy was also used for comparison, followed by conventional urethrography. The flexible cystoscope was introduced into the posterior urethra and the area was evaluated for the length of the proximal urethra and any possible fistulas, false passages, calculi or displacement of the posterior urethra. Results: Severe allergic reaction or obvious discomfort did not occur in any patients after conventional urethrography or flexible cystoscopy. By comparing the data obtained from flexible cystoscopy to those from conventional urethrography, no statistical difference was found in the measured length of the proximal posterior urethra (4.31 ± 2.28 vs. 4.02 ± 3.12, p > 0.05). However, the rate of detection in other abnormalities was higher in flexible cystoscopy than in conventional urethrography (48.3 vs. 10.8%, p < 0.05). Seventeen (14.2%), 9 (7.5%) and 32 (26.7%) patients were detected with fistula, false passage and calculus, respectively, according to flexible cystoscopy. In comparison, fistula, false passage and calculus were only observed in 2 (1.7%), 7 (5.8%) and 4 (3.3%) patients, respectively, through conventional urethrography imaging. Conclusions: Flexible cystoscopy is a valuable procedure in the evaluation of the posterior urethra and bladder neck, and in patients with urethral distraction defects before surgery. More details about fistulas, false passages, calculi and urethral defects could be obtained through this method.

Diagnosis of male posterior urethral stricture: comparison of 64-MDCT urethrography vs. standard urethrography

There are no reports regarding voiding/retrograde urethrography with 64-row multidetector CT (64-MDCT).To compare the clinical relevance of conventional voiding/retrograde urethrography and 64-MDCT urethrography for the evaluation of male posterior urethral stricture. From January to October 2009, 21 men were referred to our institution for the management of posterior urethral stricture. The patients were evaluated with conventional voiding and retrograde urethrography and 64-MDCT urethrography. The patients were examined by open operative intervention which was required in all patients. The radiologic data were compared using the operative findings. 64 MDCT urethrography provided extra clinical data in ten patients. It was superior to conventional urethrography for judging the urethral stricture length in three patients, characterizing the site of urethra-rectal fistula in four patients, and accurately delineating the proximal urethra in six patients. 64-MDCT urethrography is a promising tool as an alternative to traditional radiographic methods for defining male urethral strictures. It has the advantage of examining patients only in one position, without distortion, and by generating three-dimensional images; it can accurately measure the stricture length, aid in the diagnosis of some associated pathological conditions, such as urethrorectal fistula, and does not expose the physician to radiation.

Comparison of sonourethrography and retrograde urethrography in the evaluation of anterior urethral strictures

Radiographic retrograde urethrography (RUG) has traditionally been the preferred technique used by urologists to image the anterior urethra. Since originally described by McAninch et aL in 1988, ultrasonic imaging of the urethra has evolved into a powerful and clinically useful tool for the accurate delineation of urethral pathology. However the posterior urethra cannot be assessed reliably using this technique. Sonourethrography has proved to be more accurate than conventional radiographic urethrography in measuring stricture length throughout the anterior urethra. The objective and purpose of this study was to assess the efficacy of sonourethrography in the evaluation of anterior urethral strictures and also to explain its many advantages over traditional imaging technique.

Uretrosonografía. Comparación con la uretrografía convencional en la estenosis de uretra masculina

ObjectiveTo define the role of transurethral ultrasound in the study of male urethral structure. Material and methodsA prospective study was carried out in 19 consecutive patients with male urethral structure, diagnosed by means of conventional urethrography, who subsequently underwent trans-urethral ultrasound.The latter study consisted of the introduction of a Foley catheter (8 or 10 F) and gradual inflation of the balloon within the navicular fossa. Sterile saline solution was then slowly and continuously infused while the ultrasound was carried out by placing the trasducer on the ventral aspect of the penis and in the perineal region to identify the different portions of the urethra. The location and extension of the structure were determined by both radiological techniques, and adjacent areas of fibrosis (spongiofibrosis) were detected by ultrasound. The results correlated with the pathological findings in 10 cases. ResultsThere was good agreement between the two techniques in the localization of the structure (kappa = 0.81). However, there were statistically significant differences in the measurement of the extension (p = 0.01). Transurethral ultrasound revealed areas of spongiofibrosis adjacent to the structure that presented a different echogenicity. The results of the measurement of their extension were not significantly different from those found in the pathological study. ConclusionTransurethral ultrasound is more effective than conventional urethrography in the study of urethral structure since it permits the precise measurement and localization of the structure and the visualization of the zone of spongiofibrosis, a determining factor in surgical planning.

Sono-Urethrography in the Evaluation of Anterior Urethral Strictures

During a 7-year period 123 paired urethrographic and sono-urethrographic studies were performed on 101 patients with 110 urethral strictures. In all but 3 cases the urethra was subsequently evaluated either cystoscopically or at open operation. Sono-urethrography readily identified urethral calculi, diverticula and false passages. It correctly identified the stricture and its site in every case. There was a significant difference between stricture length as measured by urethrography compared to that measured by sono-urethrography (p less than 0.003). However, if the strictures were grouped based on anatomical location, there was good correlation and no significant difference in the penile urethra (correlation coefficient = 0.94, p = 0.74) but poor correlation and the significant difference remained in the urethral bulb (correlation coefficient = 0.64, p less than 0.007). Similarly, when urethrographic and sono-urethrographic stricture lengths were compared with operative lengths, in the penile urethra the correlation coefficients were close (correlation coefficient = 0.91 versus 0.98) but in the urethral bulb the poor correlation persisted (correlation coefficient = 0.69 versus 0.89). Although sono-urethrography certainly identifies periurethral tissue, it was unreliable in predicting the depth of spongiofibrosis when compared with full depth biopsies in 36 patients with histopathological correlation. Finally, in 16 percent of the patients sono-urethrography correctly indicated a reconstructive procedure different from that originally suggested by conventional urethrography. Sono-urethrography is a dynamic 3-dimensional study that accurately identifies stricture site, number and caliber. Compared with conventional urethrography, it more accurately measures stricture length and diameter, and identifies periurethral tissue, making it a valuable adjunct in the evaluation of patients with suspected anterior urethral strictures.

Sonography in the evaluation of the male anterior urethra

Contrast ascending urethrography is the technique most commonly used to evaluate the male anterior urethra. Sonography of the anterior urethra was prospectively evaluated in 24 consecutive referrals for conventional urethrography. In 11 patients both the sonographic and the contrast urethrograms were considered normal. Both studies demonstrated one or more strictures in nine patients but ultrasound also demonstrated periurethral cuffing in three of these. Sonography demonstrated a mucosal flap missed on the contrast study and also showed that suspected bubbles seen on the contrast study were true urethral filling defects. Diverticula were seen in three contrast studies. Two were demonstrated sonographically but the third, a shallow diverticulum in a patient with a complex stricture, was not seen on the sonogram. Mucosal irregularity was observed in five patients, and lack of urethral distensibility was demonstrated in a further five patients, by both techniques. Reflux into prostatic and Cowper's ducts could not be detected by ultrasound. Sonography offers advantages over conventional urethrography both in terms of abnormalities detected and convenience of the study.