Department of Urology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Department of Radiology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland.
Int Urol Nephrol. 2021 Dec;53(12):2423-2435. doi: 10.1007/s11255-021-02994-5. Epub 2021 Oct 2.
To 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.
55 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.
MRU 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.
VCUG 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.
验证哪种诊断方式——排尿性膀胱尿道造影（VCUG）、超声尿道造影（SUG）或磁共振尿路造影（MRU）在男性尿道狭窄的评估中最准确，以及在哪些情况下应用新型成像技术最有益。
本前瞻性研究纳入了 55 名男性尿道狭窄患者。尿道狭窄的初步诊断基于病史、尿流率和 VCUG。在手术前进行了额外的影像学检查——SUG 和 MRU。根据 MRU 数据，创建了带有狭窄的尿道的虚拟模型和 3D 打印模型。通过每种影像学方法评估精确的狭窄长度和位置，并在术中进行验证。评估 SUG 和 MRU 对海绵纤维化的评估的一致性。MRU 图像由两名放射科医生（MRU1、MRU2）独立解读，并计算评分者间信度。
MRU 是最准确的[(95% CI 0.786-0.882)，p < 0.0005]，与手术测量相比，平均高估 1.145mm（MRU1）和 0.727mm（MRU2）。VCUG 不太准确[(95% CI 0.536-0.769)，p < 0.0005]，与手术测量相比，平均低估 1.509mm。SUG 是最不准确的方法[(95% CI 0.510-0.776)，p < 0.0005]，与手术测量相比，平均高估 2.127mm。两名放射科医生对 MRU 解读的一致性几乎是完美的。
尽管 VCUG 存在局限性，但它仍被认为是诊断尿道狭窄疾病的“金标准”。SUG 和 MRU 为术前规划提供了额外的指导，应被视为诊断尿道狭窄的补充手段。VCUG 和 SUG 的组合可能是诊断位于阴茎尿道的尿道狭窄患者的最佳影像学工具集。MRU 是最准确的方法，在创伤后或多发性狭窄和后尿道狭窄的情况下尤其应考虑使用。
