Ascending Urethrogram and Sonourethrogram in Evaluation of Male Anterior Urethra

Aim: To determine the efficacy and accuracy of detection and characterization of anterior urethral strictures by sonourethrogram compared to retrograde urethrogram.

Materials and Methods: A total of 45 patients presented during the 4 months duration of the study. 31 patients qualified for the study; however 2 of these patients were excluded due to technical difficulties encountered during the sonourethrogram. The parameters studied were age, ethnicity, detection of strictures and characterization by length, location and diameter. In the RUG tapered segments on either side of the stricture were included. Age distribution, Paired t-test and correlation coefficient were examined.

Results: Age distribution of the study population was between 18-80 years. Among the study population, 58.6% were East Indian origin and 41.4% were African origin. 10 out of 29 patients showed normal anterior urethra by both RUG and SUG. Also, the two techniques correctly identified normal from abnormal study. The presence of a stricture and its location was correctly identified by both methods which were retrospectively confirmed with optical cystourethroscopy. The stricture length and diameter measured by SUG and RUG showed no statistically significant difference. The Pearson correlation coefficient(r) is 0.95 for length measurement (p<0.01) and correlation(r) is 0.837 for diameter measurement (p<0.01). Periurethral fibrosis and mucosal abnormalities were well shown by sonourethrogram. Among the strictures demonstrated by SUG, 52.6% showed periurethral fibrosis. The presence of periurethral fibrosis varied between the bulbar and penile areas, 77% in bulbar strictures compared to 24% in penile strictures.

Conclusion: Both RUG and SUG proved to be equally efficient in detecting the site of stricture and assessing the length and diameter of the stricture. We noticed that by including the tapered segments on either side of stricture in RUG, the length measurements were comparable to SUG. The periurethral fibrosis and mucosal abnormalities were well demonstrated by the SUG, which was not evident by the RUG.