Comparing the Diagnostic Accuracy of Sonourethrogram and Retrograde Urethrogram in Anterior Urethral Strictures

Introduction: Besides history and physical examination, ascending urethrogram (RGU) remained the Gold Standard for evaluating Male Urethral Stricture. But it underestimates the length of proximal bulbar urethral stricture and it also has the disadvantage of underestimating spongiofibrosis. Since sonography has become the urologist's stethoscope, the present study was aimed to compare the efficacy of sonourethogram (SUG) with respect to RGU in the diagnosis and management of urethral strictures.

Methods: A total of 23 patients meeting the inclusion and exclusion criteria were studied in detail from January 2020 to January 2022 in Department of Urology, Gandhi hospital, Secunderabad. All the patients were first subjected to RGU and those found to have stricture urethra were subjected to SUG. All patients were then subjected to urethroscopy and findings noted. Findings on both these investigations were later correlated with intraoperative findings. Discrepancy in findings of both investigations with those of intraoperative findings were recorded and tabulated. Findings in those patients with change of proposed surgery were also recorded and tabulated. The results were then compared and appropriate statistical tests were applied.

Results: Mean age group of study population in the present study was 44.43 years. In the present study, the most common type of strictures was inflammatory strictures (43.47%). This was followed by idiopathic strictures (26.08%), post catheterization strictures (17.39%) and post TURP strictures (13.04%) in decreasing order of frequency. Most common location of stricture urethra was bulbar urethra constituting about 47.82 % of study population in the present study. Second most common location was penile urethra. 14 out of 23 patients (60.86%) in RGU group had up gradation in length of stricture following SUG. Spongiofibrosis can only be assessed on SUG and cannot be measured by RGU. Mean stricture diameter on RGU was found to be 10.17Fr whereas for SUG was 9.39 Fr. Intraoperative mean stricture diameter was 9.33Fr.

Conclusion: SUG measures exact stricture length and it closely correlates with that of intraoperative findings. So an adequate preoperative planning of surgery can be made based on SUG findings. Stricture diameter on SUG correlates well with intraoperative findings rather than RGU. SUG helps in the identification of spongiofibrosis and periurethral pathology thereby helping in the proper management of patients with stricture thereby minimizing recurrence. False tracts on RGU may be missed if its opening is occluded but these false tracts can be identified on SUG. With accurate information about periurethral pathologies SUG is more useful than RGU when determining the type of operative procedure suitable for patients with strictures localized to the anterior urethra.