Presentation Authors: anuj kumar*, RAJEEV SOOD, HEMANT GOEL, UMESH SHARMA, SUMIT GAHLAWAT, HARSH JAIN, NEW DELHI, India
Introduction: Retrograde urethrography (RGU) is the standard imaging study for the evaluation of anterior male urethra. sonourethrogram (SUG) is a dynamic, 3D study which can be repeated without radiation exposure. This study was done to explore the uses of SUG in evaluating stricture disease of the male anterior urethra and comparing it with RGU and correlation with findings in urethroscopy.
Methods: In all 196 patients apart from clinical examination and RGU/MCU, SUG done 3-4 days after RGU/MCU by high frequency linear probe (10-12.5 MHz). Patient kept in supine position and ultrasound scanning was done through the ventral surface of the penis to assess the whole anterior urethra upto the bulbo-membranous junction. lignocaine jelly(2%) was used to distend the urethra. Strictures were identified as the segments with reduced distensibility upon lignocaine jelly insertion. Stricture length was measured with electronic calipers, and periurethral structures were evaluated for spongiofibrosis and the presence of false tracts, filling defects, or diverticula. The procedure was well tolerated by the patients, and there were no complications. Chiouâ€™s classification used to classify urethral stricture/ spongiofibrosis on SUG. During surgery, ureteric catheters used to determined stricture length.
Results: SUG assess the characteristics of stricture better than RGU. Complex strictures were diagnosed with higher accuracy on urethroscopy than SUG and RGU. information regarding spongiofibrosis by SUG helped in predicting the outcome of surgical procedures, plan changed to urethroplasty from DVIU in 12 patients on the basis of SUG findings. One patient with bulbar urethral stricture was also having false tract, which was better delineated by SUG and urethroscopy. sensitivity and positive predictive value of SUG is found to be >98% with intraoperative findings.
Conclusions: In the present study we have found SUG to be a multiplanner, easily available and cost effective technique for evaluating the male anterior urethra without radiation exposure. When compared with conventional RGU, SUG is equally efficacious in detecting anterior urethral stricture diseases. However, further characterization of strictures in terms of length, periurethral pathologies can be performed with greater sensitivity using the sonourethrography.