1074
SONOGRAPHIC STAGING OF ANTERIOR URETHRAL STRICTURES
whether sonographic assessment of urethral vascular anat-
omy is clinically important, further investigation with color
Doppler may be useful to assess vascularity before grafting
procedures.26
CONCLUSIONS
Because of its superficial location the male anterior ure-
thra is ideally suited for sonographic assessment. Contempo-
rary high frequency transducers produce excellent images.
Small parts transducer probes are widely available for scro-
tal or vascular imaging and, thus, special equipment is not
necessary for urethral imaging.
Sonourethrography is a simple technique that provides a
dynamic, precise assessment of anterior urethral strictures.
We believe that urethral ultrasound is best used as a staging
study in men with known symptomatic strictures in whom
the need for operative therapy is clear. As a screening study
ultrasound does not appear to offer any advantages com-
pared to standard radiographic retrograde urethrography,
and the potential additional costs of routine sonographic
screening are not warranted.
FIG. 7. Urethral ultrasound shows hair bearing (arrows) ectatic
neourethra after previous scrotal flap onlay procedure.
Because it provides reproducible quantitative information
sonourethrography is influential in planning surgical inter-
vention. For short bulbar strictures ultrasound measures
stricture length more accurately than conventional radio-
graphic retrograde urethrography and, therefore, is helpful
in determining whether to excise or graft. For long or com-
plex strictures assessment of stricture diameter may help
determine flap width or identify focal urethral segments to be
excised. The simplicity, precision and availability of sonog-
raphy, with the absence of radiation exposure, make sonoure-
thrography a valuable staging tool for the reconstructive
urologist.
REFERENCES
1. Rosen, M. A. and McAninch, J. W.: Preoperative staging of the
anterior urethral stricture. In: Traumatic and Reconstructive
Urology. Edited by J. W. McAninch. Philadelphia: W. B.
Saunders, chapt. 46, pp. 551–564, 1996
2. Jordan, G. H., Schlossberg, S. M. and Devine, C. J.: Surgery of
the penis and urethra. In: Campbell’s Urology, 7th ed. Edited
by P. C. Walsh, A. B. Retik, E. D. Vaughan, Jr. et al. Phila-
delphia: W. B. Saunders, vol. 3, chapt. 107, pp. 3318–3394,
1998
3. McAninch, J. W., Laing, F. C. and Jeffrey, R. B., Jr.: Sonoure-
thrography in the evaluation of urethral strictures: a prelim-
inary report. J Urol, 139: 294, 1988
4. Klosterman, P. W., Laing, F. C. and McAninch, J. W.: Sonoure-
thrography in the evaluation of urethral stricture disease.
Urol Clin North Am, 16: 791, 1989
5. Merkle, W. and Wagner, W.: Sonography of the distal male
urethra—a new diagnostic procedure for urethral strictures:
results of a retrospective study. J Urol, 140: 1409, 1988
6. Gluck, C. D., Bundy, A. L., Fine, C. et al: Sonographic urethro-
gram: comparison to roentgenographic techniques in 22 pa-
tients. J Urol, 140: 1404, 1988
7. Merkle, W. and Wagner, W.: Risk of recurrent stricture following
internal urethrotomy: prospective ultrasound study of distal
male urethra. Br J Urol, 65: 618, 1990
8. Arda, K., Basar, M., Deniz, E. et al: Sonourethrography in an-
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FIG. 8. Two large urethral calculi (curved arrows) surround
dense, short, chronic stricture (open arrow). Note shadowing from
calculi (solid arrows).
7). Sonourethrography has also been instrumental in select-
ing cases for repeat end-to-end urethroplasty12 in which the
risk of re-stricture is increased.24 Preliminary sonographic
staging has contributed substantially to greater success than
reported in earlier series in this challenging group of pa-
tients.12, 24, 25
OTHER APPLICATIONS
Periurethral pathology. Others have demonstrated that
associated pathological conditions of the urethra and peri-
neum may be delineated on ultrasound.1, 13, 26, 27 Urethral
calculi and periurethral abscesses, diverticulae, fistulas and
false passages are well visualized sonographically (fig. 8).
Complete preoperative knowledge of such complicating con-
ditions facilitates favorable urethroplasty outcomes.
Assessment of vascularity. Color Doppler ultrasound has
recently been used to detect urethral arterial position before
optical urethrotomy.28 Although it remains to be seen
9. Gupta, S., Majumdar, B., Tiwari, A. et al: Sonography in the
evaluation of anterior urethral strictures: Correlation with
radiographic urethrography. J Clin Ultrasound, 21: 231, 1993
10. Heidenreich, A., Derschum, W., Bonfig, R. et al: Ultrasound in
the evaluation of urethral stricture disease: a prospective
study in 175 patients. Br J Urol, 74: 93, 1994
11. Das S.: Ultrasonographic evaluation of urethral stricture dis-
ease. Urology, 40: 237, 1992
12. Morey, A. F., Duckett, C. P. and McAninch, J. W.: Failed anterior
urethroplasty: guidelines for reconstruction. J Urol, 158: 1383,
1997