Diagnosis Of Urethral Stricture Disease Research Articles

Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures. Should the novel methods become the new standard in radiological diagnosis of urethral stricture disease?

PurposeTo verify which of the diagnostic modalities: Voiding cystouretrography (VCUG), Sonouretrography (SUG) or Magnetic resonance uretrography (MRU) is the most accurate in the assessment of urethral strictures in males and in what cases the application of novel imaging techniques benefits most.Methods55 male patients with a diagnosis of urethral stricture, were enrolled in this prospective study. Initial diagnosis of urethral stricture was based on anamnesis, uroflowmetry and VCUG. Additional imaging procedures—SUG and MRU were performed before the surgery. Virtual models and 3D printed models of the urethra with the stricture were created based on the MRU data. Exact stricture length and location were evaluated by each radiological method and accuracy was verified intraoperatively. Agreement between SUG and MRU assessments of spongiofibrosis was evaluated. MRU images were independently interpreted by two radiologists (MRU 1, MRU 2) and rater reliability was calculated.ResultsMRU was the most accurate [(95% CI 0.786–0.882), p < 0.0005] with an average overestimation of 1.145 mm (MRU 1) and 0.727 mm (MRU 2) as compared with the operative measure. VCUG was less accurate [(95% CI 0.536–0.769), p < 0.0005] with an average underestimation of 1.509 mm as compared with operative measure. SUG was the least accurate method [(95% CI 0.510–0.776), p < 0.0005] with an average overestimation of 2.127 mm as compared with the operative measure. There was almost perfect agreement of MRU interpretations between the radiologists.ConclusionsVCUG is still considered as a ‘gold standard’ in diagnosing urethral stricture disease despite its limitations. SUG and MRU provide extra guidance in preoperative planning and should be considered as supplemental for diagnosing urethral stricture. Combination of VCUG and SUG may be an optimal set of radiological tools for diagnosing patients with urethral strictures located in the penile urethra. MRU is the most accurate method and should particularly be considered in cases of post-traumatic or multiple strictures and strictures located in the posterior urethra.

Urethral Stricture Disease: Evaluation of the Male Urethra.

The diagnosis of urethral stricture disease is often made when a man with obstructive voiding symptoms undergoes flexible cystoscopy (urethroscopy). However, a more complete and definitive diagnosis is then achieved when the urethra is subsequently evaluated with a retrograde urethrogram, and in many cases, a voiding cystourethrogram (VCUG). In situations where there is stricture disease involving the meatus or fossa navicularis that prevents the passage of adult flexible cystoscope, other testing appropriate in these cases include distal urethral calibration using bougie-a-boules and possibly the advancement of a pediatric cystoscope. It is only after the exact location and length and severity of the stricture is assessed that patients can be properly advised of all options before decision-making and the implementation of a treatment plan. This section will review the evaluation of the male urethra.

National Trends in the Management of Urethral Stricture Disease.

A growing body of evidence suggests that practice patterns for the management of urethral strictures are changing. We examined national trends in urethral stricture management over time using a national data set. Individuals with a new diagnosis of urethral stricture disease between 2008 and 2016 were identified within MarketScan® to determine management strategies. Repeat endoscopic management was defined as 2 or more endoscopic procedures per patient. Recommended care was defined as primary urethroplasty, a single endoscopic procedure or a single endoscopic procedure followed by urethroplasty. Linear regression and multivariate models were fit to determine trends over time. A mean of 15,621,116 beneficiaries per year were identified with a mean prevalence of urethral stricture disease of 349 strictures per 100,000 male beneficiaries. There was no significant change in urethral stricture diagnosis over time, while urethroplasty usage per stricture diagnosis increased by 43.9% (R2=0.52, p=0.003). The ratio of recommended care to repeat endoscopic care in those who underwent treatment similarly increased by 87.4% (R2=0.87, p <0.01). On multivariate analysis later year of diagnosis was associated with an increased odds of receiving recommended care while increasing age and increasing comorbidity status were associated with decreased odds. In a large national sample a significant trend toward decreased use of repeat endoscopic procedures and increased use of urethroplasty for management of urethral stricture disease was noted. These data highlight a drastic change in practice patterns over time, favoring a more definitive evidence-based approach.

MP67-03 PREDICTING URETHRAL STRICTURE SYMPTOM SEVERITY USING RETROGRADE URETHROGRAMS AND UROFLOWMETRY

INTRODUCTION AND OBJECTIVES:Retrograde urethrogram (RUG) is a mainstay in the evaluation and diagnosis of urethral stricture disease. Despite this, minimal research exists comparing parameters foun...

Validated uroflowmetry-based predictive model for the primary diagnosis of urethral stricture disease in men.

To define a uroflowmetry-based non-invasive predictive tool for the primary diagnosis of urethral stricture disease. A total of 300 male patients (150 with urethral stricture disease and 150 with benign prostatic obstruction), treated surgically between 2005 and 2015, and 75 healthy males were included in this study. Patients were randomly assigned to one of two groups (75 benign prostatic obstruction patients and 75 urethral stricture disease patients in each group). A model, able to objectively differentiate between benign prostatic obstruction and urethral stricture disease, was created by use of original and hybrid uroflowmetry variables in logistic regression in groupA (test group). Receiver operating characteristics curve analysis was used for validation in groupB (validation group) and to calculate cut-off values to distinguish healthy individuals from benign prostatic obstruction as a result of urethral stricture disease. Receiver operating characteristics area under the curve values of the created model were 0.841 (0.777-0.905) and 0.807 (0.735-0.879) in groups A and B, respectively. Optimal cut-off values were 2.2847 and 0.1182 to distinguish healthy individuals versus benign prostatic obstruction and benign prostatic obstruction versus urethral stricture disease. A triphasic uroflowmetry-based model is able to objectively distinguish voiding patterns of healthy individuals, benign prostatic obstruction and urethral stricture disease. The probability of urethral stricture disease can be objectively calculated for each individual patient based on a non-invasive uroflowmetry test. Uroflowmetry pattern interpretation by use of statistical models could become a new standard.

615 MR urethrography versus conventional cystourethrography in diagnosis of urethral stricture disease with surgical findings correlation

615 MR urethrography versus conventional cystourethrography in diagnosis of urethral stricture disease with surgical findings correlation

Patterns of Management of Urethral Stricture Disease in the Veterans Affairs System

To describe the number of urethral dilations, urethrotomies, and urethroplasties performed on men with a diagnosis of urethral stricture disease seeking care in the Veterans Affairs (VA) health care system in southern California and southern Nevada over a 5-year period. To date, few health services research studies have evaluated patterns of care for urethral stricture disease using national datasets. We analyzed stricture treatment for male veterans with an ICD-9 diagnosis code for urethral stricture in the National Patient Care Database (NPCD). Encounters for urethral stricture procedures performed were identified based on the presence of Physicians Current Procedural Terminology Coding System (4th edition, CPT-4) codes for treatments performed during the fiscal years 2002-2006. A total of 1457 men carried a diagnosis of urethral stricture disease during the index time period. Of these, 333 men (23%) underwent 431 procedures. Of the 216 men who underwent urethral dilations, 170 (79%) underwent only 1 procedure and 26 (12%) underwent 2 procedures. Of the 79 men who underwent urethrotomy, 76 (96%) underwent 1 procedure. Sixteen men (5%) underwent a urethroplasty, 8 of whom underwent a perineal urethrostomy. The vast majority of men treated for stricture disease underwent only 1 such procedure over a 5-year time period. Further research is required to investigate whether this is a quality-of-care issue or patients refusing intervention. It is possible that some patients may be temporized for a significant period with dilation/urethrotomy, whereas those with rapid recurrence require early urethroplasty.

Prospective Evaluation of the American Urological Association Symptom Index and Peak Urinary Flow Rate for the Followup of Men With Known Urethral Stricture Disease

We prospectively evaluated the American Urological Association (AUA) symptom index and maximum urine flow for predicting urethral stricture recurrence in men with a previous diagnosis of urethral stricture disease. Patients were recruited at our urethral stricture clinic, where all newly diagnosed and previously treated men with urethral stricture present and are treated. The AUA symptom index was completed and uroflowmetry was done. The stricture was calibrated using Jacques catheters. If an 18Fr catheter could not be passed, a retrograde urethrogram was performed. Patients were treated with filiform dilation or direct vision internal urethrotomy. Uroflowmetry was repeated when the catheter was removed 3 days later and the AUA symptom index was repeated 1 month later. Data on 49 patients (170 consultations) between March 2000 and August 2001 were analyzed. Average patient age was 48 years. There was a significant negative correlation of urethral diameter with AUA symptom index and of AUA symptom index with maximum urine flow as well as a significant positive correlation of urethral diameter with maximum urine flow. We evaluated the usefulness of AUA symptom index and maximum urine flow at different cutoff levels for predicting urethral stricture in our study group. Using an AUA symptom index of greater than 10 or maximum urine flow of less than 15 ml. per second as cutoff values provided 93% sensitivity, 68% specificity, 78% positive predictive value, 89% negative predictive value and 82% overall accuracy. This method could have prevented further invasive studies in 34% of patients, while a clinically significant stricture would have been missed in only 4.3%. AUA symptom index combined with maximum urine flow is an accurate, time-saving and cost-effective tool for predicting recurrent stricture in patients with a known urethral stricture. It can be used to direct decision making on further invasive studies and treatment.