Miszewski Kevin, Krukowski Jakub, Miszewska Laura, Kulski Jakub, Stec Roland, Skrobisz Katarzyna, Matuszewski Marcin
Department of Urology, Medical University of Gdańsk, 17 Smoluchowskiego St., 80-214 Gdańsk, Poland.
Faculty of Medicine, Medical University of Gdańsk, 17 Smoluchowskiego St., 80-214 Gdańsk, Poland.
J Clin Med. 2025 Jun 23;14(13):4453. doi: 10.3390/jcm14134453.
: Urethral stricture disease involves fibrotic scarring that narrows the urethral lumen and can occur at any site. Sonourethrography (SUG) is increasingly used because it depicts both luminal anatomy and periurethral fibrosis, yet little is known about patient or lesion features that influence its diagnostic performance. : We conducted a prospective single-center study of 170 men who underwent SUG before anterior urethroplasty between May 2016 and May 2021. Anthropometric data, comorbidities, and detailed ultrasonographic measurements were recorded and compared with intra-operative findings, which served as the reference standard. Accuracy was analyzed with Wald chi-square testing and Spearman correlation. : SUG length estimates matched intra-operative measurements in 139/170 strictures (81.8%). Length accuracy was higher in patients ≥ 60 years (89.2% vs. 77.0%, = 0.03) and in those with type 2 diabetes (92.3% vs. 80.9%, = 0.02) in conditions associated with pronounced spongiofibrosis that enhances echo contrast. Among stricture-specific factors, proximal location (63.6% vs. 84.5%, = 0.01) and complete luminal occlusion (68.8% vs. 84.8%, = 0.02) reduced precision, largely because deeper anatomy and absent saline flow hinder acoustic delineation. The Chiou ultrasonographic grade was the strongest determinant of performance; higher grades yielded clearer margins and better length estimation ( < 0.001). : SUG is a reliable bedside technique for assessing anterior urethral strictures, but its accuracy varies with age, diabetes status, stricture site, degree of occlusion, and fibrosis grade. Recognizing these determinants allows clinicians to judge when SUG alone is sufficient and when complementary imaging or heightened caution is warranted. The findings support tailored imaging protocols and underscore the need for multi-center studies that include operators with diverse experience to confirm generalisability.
尿道狭窄疾病涉及导致尿道管腔狭窄的纤维化瘢痕形成，可发生于任何部位。超声尿道造影（SUG）因其既能显示管腔解剖结构又能显示尿道周围纤维化而越来越多地被使用，但对于影响其诊断性能的患者或病变特征知之甚少。
我们对2016年5月至2021年5月期间在接受前尿道成形术前行SUG检查的170名男性进行了一项前瞻性单中心研究。记录人体测量数据、合并症和详细的超声测量结果，并与作为参考标准的术中发现进行比较。采用Wald卡方检验和Spearman相关性分析准确性。
在170例狭窄中，139例（81.8%）的SUG长度估计与术中测量结果相符。在海绵体纤维化明显增强回声对比的情况下，年龄≥60岁的患者（89.2%对77.0%，P = 0.03）和2型糖尿病患者（92.3%对80.9%，P = 0.02）的长度准确性更高。在狭窄特异性因素中，近端位置（63.6%对84.5%，P = 0.01）和管腔完全闭塞（68.8%对84.8%，P = 0.02）降低了准确性，主要是因为更深层的解剖结构和无盐水流动阻碍了声学描绘。邱氏超声分级是性能的最强决定因素；分级越高，边缘越清晰，长度估计越好（P < 0.001）。
SUG是评估前尿道狭窄的可靠床边技术，但其准确性随年龄、糖尿病状态、狭窄部位、闭塞程度和纤维化分级而变化。认识到这些决定因素使临床医生能够判断何时仅SUG就足够，何时需要补充成像或提高警惕。这些发现支持定制成像方案，并强调需要进行多中心研究，纳入具有不同经验的操作人员以确认其普遍性。
