Urethral Stricture Disease: Evaluation of the Male Urethra

Abstract

The diagnosis of urethral stricture disease is often made when a man with obstructive voiding symptoms undergoes flexible cystoscopy (urethroscopy). However, a more complete and definitive diagnosis is then achieved when the urethra is subsequently evaluated with a retrograde urethrogram, and in many cases, a voiding cystourethrogram (VCUG). In situations where there is stricture disease involving the meatus or fossa navicularis that prevents the passage of adult flexible cystoscope, other testing appropriate in these cases include distal urethral calibration using bougie-a-boules and possibly the advancement of a pediatric cystoscope. It is only after the exact location and length and severity of the stricture is assessed that patients can be properly advised of all options before decision-making and the implementation of a treatment plan. This section will review the evaluation of the male urethra.

Keywords: urethra; urethral imaging; urethral stricture.

FIG. 1.

RUG obtained shortly after discontinuation of catheterization. RUG = retrograde urethrogram.

FIG. 2.

RUG, same patient, after 3 months of urethral rest subsequent to suprapubic urinary diversion, clearly demonstrating stricture length and location and severity.

FIG. 3.

Technique of RUG.

FIG. 4.

RUG demonstrating a proximal bulbar stricture (arrow).

FIG. 5.

VCUG not only demonstrating the bulbar stricture (arrow) seen on the RUG in Figure 4 but also demonstrating the wide patency of the posterior urethra. VCUG = voiding cystourethrogram.

FIG. 6.

Christmas tree type adaptor (left), adult Taylor adaptor (center), pediatric Taylor adaptor (right).

FIG. 7.

RUG with simultaneous cystourethrogram obtained with injection of contrast through a flexible cystoscope with the tip at or distal to the verumontanum.

FIG. 8.

Image demonstrating the length and location of a pelvic fracture urethral injury.

FIG. 9.

RUG in a patient with a history of radiation.

FIG. 10.

VCUG demonstrating the membranous radiation stricture and confirming wide patency of the bladder neck and prostatic urethra.

FIG. 11.

Balloon inflation with only 2 cc within the fossa navicularis dilates the urethra to ∼50F.