Learning objectives
1.
To understand normal urethral anatomy
2.
To be able to perform a urethrogram
3.
To appreciate the different indications for a study
4.
To have an overview of the different aetiologies for urethral strictures
5.
To have an understanding of strategies for difficult studies,
such as trauma patients.
6.
To have an understanding of the different surgical options available for stricture management.
7.
To understand the relevance of the different urethrogram appearances and how these impact on the surgical management
Background
Urethral strictures have been well recognised since ancient times with reports in Greek and Egyptian literature.
More recently,
urethrography with antegrade passage of iodinated contrast was developed by Knutsson in the early 20th century.
His eponymous clamp served 2 functions; to catheterise the distal penile urethra whilst the clamp element constricted the gland penis around the catheter.
Retrograde injection of iodinated contrast was therefore obliged to pass proximally up the urethra.
Although a number of variations have been described,
most radiologists utilise a more conventional...
Imaging findings OR Procedure details
Indications
The majority of requests for urethrography are due to a clinical suspicion of urethral stricture.
Typical symptoms are those of hesitancy,
poor stream,
terminal dribbling and most commonly the sense of incomplete bladder emptying[1].
A urinary flow rate trace typically shows a long slow protracted curve in a relatively young male patient.
The urethrogram should demonstrate the anatomical site,
multiplicity and length of any strictures,
thereby allowing appropriate urological surgical intervention.
Many strictures are found at rigid cystoscopy.
If short and in the bulbar...
Conclusion
A urethrogram is an essential tool for the contemporary radiologist and careful interpretation of a good quality study is essential for appropriate surgical management.
References
References
1. Mundy,
A.R.
and D.E.
Andrich,
Urethral strictures. BJU Int.
107(1): p.
6-26.
2. Ingram,
M.D.,
et al.,
Urethral injuries after pelvic trauma: evaluation with urethrography. Radiographics,
2008.
28(6): p.
1631-43.
3. Amis,
E.S.,
Jr.,
J.H.
Newhouse,
and J.J.
Cronan,
Radiology of male periurethral structures. AJR Am J Roentgenol,
1988.
151(2): p.
321-4.
4. Kawashima,
A.,
et al.,
Imaging of urethral disease: a pictorial review. Radiographics,
2004.
24 Suppl 1: p.
S195-216.
5. Koraitim,
M.M.,
Pelvic fracture urethral injuries: evaluation of various methods of...