TY - JOUR
T1 - Imaging of the male urethra for stricture disease
AU - Gallentine, Michael L.
AU - Morey, Allen F.
PY - 2002/5
Y1 - 2002/5
N2 - Imaging of the urethra for suspected stricture disease should initially consist of conventional imaging with a dynamic RUG. It is easy to perform and detects clinically relevant strictures involving the anterior urethra and those with extension into the membranous urethra. Additional studies, including antegrade imaging, sonographic urethrography, and MRI are best used in conjunction with RUG as clinically indicated to better define the extent of disease and assist in guiding reconstruction. Post-operatively, VCUG is appropriate to evaluate complete healing and adequacy of repair. Sonourethrography is a simple technique that provides a dynamic, precise assessment of anterior urethral strictures. It is best employed as a staging study in men with known symptomatic strictures in whom the need for operative therapy is clear. For short bulbar strictures ultrasound is more accurate in measuring stricture length than conventional radiographic RUG and is therefore helpful in determining whether to excise or graft. For long or complex strictures assessment of the stricture's diameter may be helpful in determining flap width or in identifying the focal urethral segments to be excised. The simplicity, precision, and availability of sonography along with the absence of radiation exposure make sonourethrography a valuable staging tool for the reconstructive urologist. MRI is valuable for defining the distorted pelvic anatomy that is frequently associated with posterior urethral strictures resulting from trauma. By determining the location of the prostate and the length of the prostatomembranous defect, MRI may help determine whether a transperineal or transpubic approach for reconstruction is necessary.
AB - Imaging of the urethra for suspected stricture disease should initially consist of conventional imaging with a dynamic RUG. It is easy to perform and detects clinically relevant strictures involving the anterior urethra and those with extension into the membranous urethra. Additional studies, including antegrade imaging, sonographic urethrography, and MRI are best used in conjunction with RUG as clinically indicated to better define the extent of disease and assist in guiding reconstruction. Post-operatively, VCUG is appropriate to evaluate complete healing and adequacy of repair. Sonourethrography is a simple technique that provides a dynamic, precise assessment of anterior urethral strictures. It is best employed as a staging study in men with known symptomatic strictures in whom the need for operative therapy is clear. For short bulbar strictures ultrasound is more accurate in measuring stricture length than conventional radiographic RUG and is therefore helpful in determining whether to excise or graft. For long or complex strictures assessment of the stricture's diameter may be helpful in determining flap width or in identifying the focal urethral segments to be excised. The simplicity, precision, and availability of sonography along with the absence of radiation exposure make sonourethrography a valuable staging tool for the reconstructive urologist. MRI is valuable for defining the distorted pelvic anatomy that is frequently associated with posterior urethral strictures resulting from trauma. By determining the location of the prostate and the length of the prostatomembranous defect, MRI may help determine whether a transperineal or transpubic approach for reconstruction is necessary.
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U2 - 10.1016/S0094-0143(02)00028-9
DO - 10.1016/S0094-0143(02)00028-9
M3 - Review article
C2 - 12371227
AN - SCOPUS:0036586918
SN - 0094-0143
VL - 29
SP - 361
EP - 372
JO - Urologic Clinics of North America
JF - Urologic Clinics of North America
IS - 2
ER -