A Comparison of Sonourethrography and Retrograde Urethrography in Evaluation of Anterior Urethral Strictures: Sonourethrography and Retrograde Urethrography in Evaluation of Anterior Urethral Strictures

Zubair  Janan Orakzai; Sumera  Nighat; Sana  Sharif; Mahwish  Zahra

doi:10.54393/pbmj.v5i6.576

Authors

Zubair Janan Orakzai MTI Mardan Medical Complex, Mardan
Sumera Nighat Bakhtawar Amin Memorial and Trust Hospital, Multan
Sana Sharif BUMDC, PNS Shifa Karachi
Mahwish Zahra Children Hospital Multan

DOI:

https://doi.org/10.54393/pbmj.v5i6.576

Keywords:

Sonourethrography, urinary pathway, RGU, sensitivity, specificity

Abstract

The urinary tract has restrictions in its lower parts. This problem can be detected by two different methods. Obstruction in the anterior portion of this tract can be diagnosed by some available standard methods. Objective: To assess the general problems in the male urethra specifically in the anterior portion. Methods: It is a prospective and comparative study with a statistical approach, conducted at Bakhtawar Amin Memorial and Trust Hospital, Multan and MTI Mardan Medical Complex, Mardan for the duration of one year from December 2020 to December 2021. The study was done by using ultrasound of high resolution. Then the comparison of the operative conclusions has to be done with retrograde urethrography (RGU) to find out the efficiency of RGU. For this study work, seventy-seven patients were selected. All these patients had some restrictions in the urinary pathway confirmed by retrograde urethrography. Different characteristics of the patients were studied and matched with the available standard methods. By both tests specificity, sensitivity, and overall accuracy of the protocol were also assessed. Different statistical analyses were performed to find out the results. Results: All the seventy-seven patients were having some restriction of urinary pathway, which were detected by sonourethrography and further confirmation was done by other previously verified methods. The retrograde urethrography shows almost very low sensitivity of this particular problem detection. This test was about 60 to 80% sensitive for this diagnosis. This sensitivity is specific for the length of about 1 to 5 cm. These results were compared with the results of sonourethrography. The problem termed as spongiofibrosis was also diagnosed with sensitivity about 76 to 82 %. A number of other problems were also detected by this method like calculi and further confirmation was done at the time of surgery. The probability was greater than 0.001 and difference in frequency was also not so significant. It was less than 0.5. Conclusions: Both of the methods have equal efficiency for the detection of different restrictions in urinary tract. When other parameters were assessed; it was inferred that sonourethrography is more efficient method

References

Mundy AR, Andrich DE. Urethral strictures. BJU Int. 2011 Jan;107(1):6-26. doi: 10.1111/j.1464-410X.2010.09800.x

Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W. Etiology of urethral stricture disease in the 21st century. J Urol. 2009 Sep;182(3):983-7. doi: 10.1016/j.juro.2009.05.023.

Santucci RA, Joyce GF, Wise M. Male urethral stricture disease. J Urol. 2007 May;177(5):1667-74. doi: 10.1016/j.juro.2007.01.041.

McCallum RW, Colapinto V. Urological Radiology of the Adult Male Lower Urinary Tract: Anatomy, Physiology, Pathology and Sequelae, Diagnosis and Management. Springfield, Ill.: CC Thomas; 1976.

Davis HJ, Cian LG. Positive pressure urethrography: a new diagnostic method. J Urol. 1956 Apr;75(4):753-7. doi: 10.1016/s0022-5347(17)66877-0

Shapeero LG, Friedland GW, Perkash I. Transrectal sonographic voiding cystourethrography: studies in neuromuscular bladder dysfunction. AJR Am J Roentgenol. 1983 Jul;141(1):83-90. doi: 10.2214/ajr.141.1.83.

McAninch JW, Laing FC, Jeffrey RB Jr. Sonourethrography in the evaluation of urethral strictures: a preliminary report. J Urol. 1988 Feb;139(2):294-7. doi: 10.1016/s0022-5347(17)42391-3.

Devine JrCJ. Surgery of the urethra. In: Walsh PC, Gittes PC, Perlmutter AD, Stamey TA, editors. Campbell's urology, 5th ed. Philadelphia: WB Saunders; 1986. p. 2860-3.

Nash PA, McAninch JW, Bruce JE, Hanks DK. Sono-urethrography in the evaluation of anterior urethral strictures. J Urol. 1995 Jul;154(1):72-6. doi.10.1016/S0022-5347(01)67231-8

Morehouse DD, Belitsky P, Mackinnon K. Rupture of the posterior urethra. J Urol. 1972 Feb;107(2):255-8. doi: 10.1016/s0022-5347(17)60996-0.

Albers P, Fichtner J, Brühl P, Müller SC. Long-term results of internal urethrotomy. J Urol. 1996 Nov;156(5):1611-4 doi.10.1016/S0022-5347(01)65461-2

Gluck CD, Bundy AL, Fine C, Loughlin KR, Richie JP. Sonographic urethrogram: comparison to roentgenographic techniques in 22 patients. J Urol. 1988 Dec;140(6):1404-8. doi: 10.1016/s0022-5347(17)42056-8.

Merkle W, Wagner W. Sonography of the distal male urethra--a new diagnostic procedure for urethral strictures: results of a retrospective study. J Urol. 1988 Dec;140(6):1409-11. doi: 10.1016/s0022-5347(17)42057-x

Heidenreich A, Derschum W, Bonfig R, Wilbert DM. Ultrasound in the evaluation of urethral stricture disease: a prospective study in 175 patients. Br J Urol. 1994 Jul;74(1):93-8. doi: 10.1111/j.1464-410x.1994.tb16553.x

Wagner M, Bayne A, Daneshmand S. Application of the Yang-Monti channel in adult continent cutaneous urinary diversion. Urology. 2008 Oct;72(4):828-31. doi: 10.1016/j.urology.2008.06.015.

Albers P, Fichtner J, Brühl P, Müller SC. Long-term results of internal urethrotomy. J Urol. 1996 Nov;156(5):1611-4.

Gupta S, Majumdar B, Tiwari A, Gupta RK, Kumar A, Gujral RB. Sonourethrography in the evaluation of anterior urethral strictures: correlation with radiographic urethrography. J Clin Ultrasound. 1993 May;21(4):231-9. doi: 10.1002/jcu.1870210404.

Morey AF, McAninch JW. Role of preoperative sonourethrography in bulbar urethral reconstruction. J Urol. 1997 Oct;158(4):1376-9

Webster GD, Koefoot RB, Sihelnik SA. Urethroplasty management in 100 cases of urethral stricture: a rationale for procedure selection. J Urol. 1985 Nov;134(5):892-8. doi: 10.1016/s0022-5347(17)47512-4.

Morey AF, McAninch JW. Sonographic staging of anterior urethral strictures. J Urol. 2000 Apr;163(4):1070-5. doi./10.1016/S0022-5347(01)64219-8

McCammon KA, Zuckerman JM, Jordan GH. Surgery of the penis and urethra. Alan J wein, Louis R kavoussi, Alan W partin, Craig A peters, editors. Campbell-Walsh Urology. 11th ed. Philadelphia: Elsevier. 2016:907-45.

Klosterman PW, Laing FC, McAninch JW. Sonourethrography in the evaluation of urethral stricture disease. Urol Clin North Am. 1989 Nov;16(4):791-7. doi.10.1016/S0094-0143(21)01812-7

Mullin EM, Peterson LJ, Paulson DF. Retrograde urethrogram: diagnostic aid and hazard. J Urol. 1973 Oct;110(4):462-6. doi.10.1016/S0022-5347(17)60251-9