Strictures of the male urethra: how to perform and evaluate radiourethrography and sonourethrography to avoid mistakes
Babnik Peskar, Darja ; Višnar-Perovič, Alenka
Introduction. Precise evaluation of the uretheral stricture localisation, length, depth and quality of wall changes are necessary for the selection of the optimal treatment to prevent recurrences. ...Decision for urethral dilatation, internal urethrotomy or open surgery depends on urethroscopic, radiourethrographic-RUG, and recently, according to MC Annich, also sonourethrographic-SUG results. SUG adds information about the depth and density of spongiofibrosis. Previously published findings of RUG length underestimation, compared to SUG and endoscopy, were responsible for inappropriate treatment and recurrences. In our article, we evaluate SUG as a new imaging method in the diagnosis of uretheral strictures and treatment planning, and describe both imaging methods together with usual pitfalls in performance or interpretation, possible reason for incorrect length measurements, and RUG length underestimation. Patients and methods. In the period of 20 months, we evaluated SUG compared to RUG and endoscopy in 51/130 males with suspected urethral strictures. Results. Compared to RUG, sonographywas correct in 92% radiographycally detected strictures. Length measurements by sonography were 22% shorter than radiographic lengths, which could be explained by radiographic magnification, as it was proved with wire measure placed on penis. Considering radiographic magnification, we did not find important differences in any measurement. Opposite to previously published RUG results compared to endoscopy and SUG, radiographic length underestimation was not found. Conclusions. The combination of both imaging methods provides optimal information about urethral stricture anatomy. We conclude that published radiographic length underestimation could be only a misinterpretation. (Abstract truncated at 2000 characters).
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