Abstract
Urethral strictures arise from a variety of etiologies, most commonly either iatrogenic or inflammatory in the anterior urethra and iatrogenic/surgical or traumatic etiologies in the posterior urethra. Diagnosis and treatment planning depend on urethrography, usually performed with a combination of retrograde urethrography (RUG) and voiding cystourethrography (VCUG) to evaluate the anterior and posterior urethra, respectively. While this is most commonly performed fluoroscopically, sonographic urethrography is an alternative, although at the expense of the posterior urethra, it is only visualized using a transrectal approach. In addition to understand urethral anatomy, familiarity with normal periurethral structures is necessary to avoid misdiagnosis, such as Cowper’s ducts, the glands of Littré, and the prostatic and ejaculatory ducts. Surgical management depends on the stricture location, length, and number and options range from balloon dilatation to endoscopic urethrotomy to anastomotic and substitution urethrotomy. Postprocedural management includes urethrography to identify potential complications including urethral leak, graft failure, and stricture recurrence.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Hampson LA, McAninch JW, Breyer BN (2014) Male urethral strictures and their management. Nat Rev Urol 11(1):43–50
Santucci RA, Joyce GF, Wise M (2007) Male urethral stricture disease. J Urol 177(5):1667–1674
Childs DD, Dyer RB, Holbert B, et al. (2019) Multimodality imaging of the male urethra: trauma, infection, neoplasm, and common surgical repairs. Abdominal Radiology 44:3935–3949
Mundy AR, Andrich DE (2011) Urethral strictures. BJU Int 107(1):6–26
Lumen N, Hoebeke P, Willemsen P, et al. (2009) Etiology of urethral stricture disease in the 21st century. J Urol 182(3):983–987
Cavalcanti A, Costa WS, Baskin LS, et al. (2007) A morphometric analysis of bulbar urethral strictures. BJU Int 100:397–402
Baskin LS, Constantinescu SC, Howard PS, et al. (1993) Biochemical characterization and quantitation of the collagenous components of urethral stricture tissue. J Urol 150:642–647
Gallantine ML, Morey AF (2002) Imaging of the male urethra for stricture disease. Urol Clin North Am 29(2):361–372
Kawashima A, Sandler CM, Wasserman NF, et al. (2004) Imaging of urethral disease: A pictorial review. RadioGraphics 24:S195–S216
Pansadoro V, Emiliozzi P (1999) Iatrogenic prostatic urethral strictures: classification and endoscopic treatment. Urology 53(4):784–789
Shaida N, Berman LH (2012) Ultrasound of the male anterior urethra. Br J Radiol 85(SpecIss1):S94–S101
Martins FE, Kulkarni SB, Joshi P, et al (2015) Management of long-segment and panurethral stricture disease. Advances in Urology Article ID 853914, 15 pages. https://doi.org/10.1155/2015/853914
Pushkarna R, Bhargava SK, Jain M (2000) Ultrasonographic evaluation of abnormalities of the male anterior urethra. Indian Journal of Radiology and Imaging 10(2):89–91
Peskar DB, Perovic AV (2004) Comparison of radiographic and sonographic urethrography for assessing urethral strictures. European Radiology 14:137–144
Steenkamp JW, Heyns CF, de Kick MS (1997) Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol 157(1):98–101
Heyns CF, Steenkamp JW, DeKock MLS, et al. (1998) Treatment of male urethral strictures: Is repeated dilation or internal urethrotomy useful? J Urol 160(2):356–358
Pahwa M, Gupta S, Pahwa M, et al (2013) A comparative study of dorsal buccal mucosa graft substitution urethroplasty by dorsal urethrotomy approach versus ventral sagittal urethrotomy approach. Advances in Urology Article ID 124836: https://doi.org/10.1155/2013/124836
Jordan GH, McCammon K (2012) Surgery of the penis and urethra In: Partin AW, Peters CA, Kavoussi LR, et al vol. 1., 12th ed. Elsevier Saunders, Oxford, pp 956–1000
Zimmerman WB, Santucci RA (2011) Buccal mucosa urethroplasty doe adult strictures. Indian Journal of Urology 27(3):364–370
Andrich DE, Dunglison N, Greenwell TJ, et al. (2003) The long-term results of urethroplasty. J Urol 170:90–92
Eltahawy EA, Virasoro R, Schlossberg SM, et al. (2007) Long-term follow-up for excision and primary anastomosis for anterior urethral strictures. J Urol 177(5):1803–1806
Barbagli G, Selli C, diCello V, et al. (1996) A one-stage dorsal free-graft urethroplasty for bulbar urethral strictures. Br J Urol 78:929–932
Andrich DE, Leach CJ, Mundy AR (2001) The Barbagli procedure gives the best results for patch urethroplasty of the bulbar urethra. BJU Int 88:385–389
Bhargava S, Chapple CR (2004) Buccal mucosal urethroplasty: is it the gold standard? BJU Int 93:1191–1193
Solanki S, Hussain S, Sharma DB, et al. (2014) Evaluation of healing at urethral anastomotic site by pericatheter retrograde urethrogram in patients with urethral stricture. Urology Annals 6(4):325–327
Al-Qudah HS, Santucci RA (2005) Extended complications of urethroplasty. Int Braz J Urol 31(4):315–323
Meeks JJ, Erickson BA, Granieri MA, et al. (2009) Stricture recurrence after urethroplasty: A systematic review. J Urol 182(4):1266–1270
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Sheehan, J.L., Naringrekar, H.V., Misiura, A.K. et al. The pre-operative and post-operative imaging appearances of urethral strictures and surgical techniques. Abdom Radiol 46, 2115–2126 (2021). https://doi.org/10.1007/s00261-020-02879-8
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00261-020-02879-8