Retrograde sagittal urethrography in diagnostics of urethral stricture disease: shifting the focus

Abstract

Background . For over a century retrograde urethrography (RUG) has offered the key method to diagnose urethral stricture (US). The disadvantage of the technique, however, is a potential high risk to underestimate the stricture length due to distorted visualization and eventual flawed surgical planning. Aim . To consider retrograde sagittal urethrography (RSU) and how it contributes to enhancing US preoperative diagnostics and treatment efficacy in clinical practice. Materials and methods . We compared the protocols of pre-op urethrograms performed by a radiologist and a urologist to surgery protocols for both patient groups. Group 1 included 154 patients who underwent US surgical treatment from 2017 to 2021 after using RSU as a diagnostic method (positioning 90°). Group 2 comprised 142 patients presented with identical disease who received surgery between 2012 to 2016 in our hospital after RUG using traditional technique (positioning 45°). Discrepancies of 5 mm and over in stricture length measurements between radiography protocols and intraoperative data were considered a diagnostic flaw (i.e. inconsistency). Treatment efficacy was compared across both groups. Results . In 87.6 % of cases in Group 1 (RSU) protocols provided by a radiologist matched intraoperative data versus 45.7 % of cases receiving accurate protocol data in Group 2 (RUG) (χ 2 = 59.15, p <0.001). Urethrogram protocols prepared by a urologist pre-operatively were accurate in 95.4 % of cases in Group 1 versus 62.0 % in Group 2 (χ 2 = 49.11, p <0.001). The overall efficiency of surgery was higher in Group 1 (91.6 %), than in Group 2 (82.4 %) (χ 2 = 5.54, p <0.01). Conclusion . RSU is an innovative technique that allows to significantly improve the accuracy of urethral stricture length measurement, resulting in greater treatment efficiency in Group 1 of patients. The proposed urethrographic technique can be recommended as a basic diagnostic procedure for anterior US in men.