To evaluate the magnetic resonance imaging (MRI) findings of traumatic bulbar stricture and to evaluate their ability to estimate repair complexity.
Eighty-nine men with traumatic bulbar stricture who underwent urethrography and MRI at least 3 months post-injury and subsequent excision and primary anastomosis were retrospectively analyzed. The associations of MRI findings, including continuity of the tunica albuginea of the corpus spongiosum, periurethral fistula, spongiofibrosis length (SFL), and distal and proximal bulbar urethral length (PBL) from the stricture, with urethrography and operative parameters were evaluated.
Mean SFL was significantly longer than mean stricture length on urethrography (14.9 vs. 7.9 mm, p < 0.0001). Periurethral fistula was found in 18 (20.2%) patients on MRI but not in 10 (55.6%) of them on urethrography. The corpus spongiosum was disrupted in 40 patients (55.1%) on MRI. On multivariate linear regression, SFL (standard coefficient, 0.25; t value, 2.31; p = 0.02) predicted operation time, while SFL (standard coefficient, 0.22; t value, 2.04; p = 0.04) and PBL (standard coefficient, -0.25; t value, -2.11; p = 0.04) independently predicted blood loss. Corporal splitting to reduce anastomotic tension and/or increase visualization during repair was needed in 33 patients (37.1%). Stricture length on urethrography (odds ratio [OR], 1.22; 95% confidence interval [CI], 1.04-1.42; p = 0.006) and corpus spongiosum disruption (OR, 5.51; 95% CI, 1.57-19.34, p = 0.005) were independent predictors for the need of corporal splitting.
In contrast to urethrography findings, MRI findings help predict traumatic bulbar stricture repair complexity.
Urology. 2019 Oct 15 [Epub ahead of print]
Akio Horiguchi, Hiromi Edo, Shigeyoshi Soga, Ryuichi Azuma, Masayuki Shinchi, Kenichiro Ojima, Tomohiko Asano, Keiichi Ito, Hiroshi Shinmoto
Department of Urology, National Defense Medical College, Saitama, Japan. Electronic address: ., Department of Radiology, National Defense Medical College, Saitama, Japan., Department of Plastic Surgery, National Defense Medical College, Saitama, Japan., Department of Urology, National Defense Medical College, Saitama, Japan.