Harris Daniel, Zhou Christopher, Girardot Jeffrey, Kidron Ariel, Gupta Shubham, Cavalcanti Andre Guilherme, Bittencourt Leonardo Kayat
Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA.
Abdom Radiol (NY). 2023 Mar;48(3):1062-1078. doi: 10.1007/s00261-022-03761-5. Epub 2023 Jan 28.
Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.
尿道狭窄疾病是指尿道管腔变窄，阻碍尿液流动。由于尿失禁、排尿不完全、排尿犹豫以及尿路感染风险增加，尿道狭窄会对日常生活产生重大影响。影像学检查是评估疑似尿道狭窄的核心，因为评估狭窄长度和严重程度对于指导手术治疗至关重要。目前使用的检查方式包括放射成像，主要是逆行尿道造影（RUG）和排尿性膀胱尿道造影（VCUG）；磁共振尿道造影（MRU）；以及超声尿道造影（SUG）。MRU作为一种能够提供高空间分辨率、多平面成像能力以及软组织类型区分功能，用于评估尿道周围结构和并发软组织缺损的检查手段，已成为近期的研究热点。多年来，MRU的检查方案不断发展，如今已包括动态排尿成像和图像重建选项。在这篇综述中，我们讨论了用于诊断和评估尿道狭窄的各种成像方式，并概述了过去十年关于MRU的文献，包括尚未纳入当前指南的推荐适应症。我们阐述了除放射成像之外的特殊诊断成像有益的情况，并结合我们的临床实践实例以及每种检查方式的技术描述进行说明。
