Sono-urethrogram versus conventional urethrogram in the assessment of urethral stricture disease: A prospective comparative study.

OBJECTIVE

The management 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 that addresses most issues of RGU/MCU. Studies comparing RGU/MCU with SUG are limited. With the objective of comparing these two imaging modalities in the evaluation of urethral stricture disease, a prospective study was conducted.

METHODS

Fifty-six patients suspected of urethral stricture disease on clinical evaluation and confirmed either on RGU/MCU or urethro-cystoscopy were included in the 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 intraoperative findings, which served as the reference standard.

RESULTS

The median length of the stricture determined intraoperatively was 16.5 mm, by RGU/MCU was 5.8 mm, and by SUG was 13.5 mm. The diagnostic accuracy for determination of the stricture location was 93% for RGU/MCU and 98% for SUG. SUG identified spongiofibrosis in 90% of patients with higher accuracy for the severe degree of spongiofibrosis.

CONCLUSION

SUG has been shown to be more accurate than RGU/MCU in estimating stricture length (both short and intermediate) and localizing the stricture location. Use of SUG in conjunction with RGU/MCU helps in better guidance of stricture management by improving preoperative assessment. Further studies with larger sample sizes are warranted.