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Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI

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Abstract

Urethral stricture disease refers to narrowing of the urethral lumen obstructing the flow of urine. Urethral strictures can significantly impact daily life due to incontinence, incomplete emptying, hesitancy, and increased risk of urinary tract infections. Imaging is central to the evaluation of suspected urethral stricture, as assessment of stricture length and severity is crucial for guidance of surgical management. The currently employed modalities include radiography, chiefly retrograde urethrography (RUG) and voiding cystourethrography (VCUG); magnetic resonance urethrography (MRU); and sonourethrography (SUG). MRU has become a recent focus of research as it provides high spatial resolution, multiplanar capacity, and soft tissue type differentiation for evaluation of periurethral compartments and concurrent soft tissue defects. The protocol for MRU has evolved over the years to now include dynamic micturition imaging and image reconstruction options. In this review, we discuss each of the imaging modalities used in the diagnosis and evaluation of urethral stricture and provide an overview of literature on MRU over the last decade, including suggested indications that have not yet been incorporated into current guidelines. We delineate scenarios where special diagnostic imaging beyond radiography is beneficial, providing examples from our practice and description of our techniques for each modality.

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Authors and Affiliations

  1. Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Daniel Harris, Christopher Zhou, Jeffrey Girardot, Shubham Gupta & Leonardo Kayat Bittencourt

  2. Nova Southeastern University College of Osteopathic Medicine, Fort Lauderdale, FL, USA

    Ariel Kidron & Shubham Gupta

  3. Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Daniel Harris, Christopher Zhou, Shubham Gupta & Andre Guilherme Cavalcanti

  4. Department of General and Specialized Surgery, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil

    Andre Guilherme Cavalcanti

  5. Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA

    Leonardo Kayat Bittencourt

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Harris, D., Zhou, C., Girardot, J. et al. Imaging in urethral stricture disease: an educational review of current techniques with a focus on MRI. Abdom Radiol 48, 1062–1078 (2023). https://doi.org/10.1007/s00261-022-03761-5

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