Over a 4 month period in 2004, 20 patients referred to the authors for management of urethral stricture disease were evaluated with conventional retrograde urethrography (RUG) and multiformat MR urethrography. The patients were then examined by urethroscopy under anesthesia to be followed by definitive endoscopic or open operative intervention. The radiographic data were compared to endoscopic and operative findings in all patients.

For the past century, RUG has been the gold standard in the diagnosis of urethral stricture disease. RUG is straight forward, readily available and cost-effective as it consists of only one plain radiograph. Nevertheless, limitations of RUG include its invasive nature and variations in technique, particularly patient positioning and amount of penile traction, that can greatly alter the radiographic appearance of the stenotic areas.

MR RUG is performed after injecting sterile lubricating gel into the urethra in a retrograde fashion. It has potential to provide data that RUG has the inability to provide (amount or degree of spongiofibrosis) while eliminating operator and technical variability. Using T1 sequences, high-contrast resolution of the urethra can be achieved. MR can also provide additional data (such as urethral masses or tumors) that conventional RUG cannot.

Analysis of the results of the 20 patients showed that accuracy for the diagnosis of urethral strictures was equal between both urethrography methods (85%). MR urethrography provided extra clinical data in seven patients (35%). It was superior to RUG in determining stricture length in two patients and had the ability to diagnose significant spongiofibrosis which altered the management decision in one patient. One patient had an unsuspected bladder tumor seen only on MR urethrography, and one patient with a complex urethrorectal fistula had characterization of the fistula that was unable to be obtained by conventional RUG. Lastly, one patient with a posterior urethral distraction defect who was unable to "void" during combined RUG and VCUG, had good visualization of the proximal segment on MR urethrography.

The authors feel that MR urethrography is a promising tool for defining anterior and posterior male urethral strictures as an alternative to traditional radiographic methods. The modality, which can eliminate some of the operator variability of conventional RUG, also has the ability to provide additional data that may aid in treatment planning for the management of urethral stricture disease.

Osman Y, El-Ghar MA, Mansour O, Refaie H, El-Diasty T

Eur Urol. 2006 Sep;50(3):587-594

Written by Michael J. Metro, MD, a Contributing Editor with UroToday.

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