Close
New

Medscape is available in 5 Language Editions – Choose your Edition here.

 

Urethral Strictures in Males Workup

  • Author: Joshua A Broghammer, MD; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
 
Updated: Nov 21, 2015
 

Imaging Studies

Urethral strictures are diagnosed based on a suggestive history, findings on physical examination, and radiographic or endoscopic techniques. The entire urethra, both proximal and distal to the strictured area, must be evaluated endoscopically and/or radiographically prior to any surgical intervention.[5]

Radiographic evaluation of the urethra with contrast studies is best achieved by retrograde urethrogram or antegrade cystourethrogram if the patient has an existing suprapubic catheter. Retrograde urethrograms and antegrade cystourethrograms are usually obtained through the radiology department, although the urologist can perform them directly. These studies can be used to diagnose and define the extent of the urethral stricture. Accurately documenting the extent and location of the stricture is important so that the most effective treatment options can be offered to the patient.

The technical aspects of a retrograde urethrogram involve placing a nonlubricated 8F or 10F urethral catheter into the fossa navicularis and inflating the balloon with 1-3 mL of sterile water until the balloon occludes the urethral lumen. A scout film is obtained. Approximately 10 mL of iodinated contrast media is then injected into the catheter under fluoroscopy, and images of the anterior urethra are taken. Extreme pressure during the injection phase can lead to extravasation and should be avoided. Do not mistake the membranous urethra for a stricture. On a retrograde urethrogram, the membranous urethra lies between the distal end of the verumontanum and the conical tip of the bulbous urethra. See the images below.

Retrograde urethrogram demonstrating bulbar urethr Retrograde urethrogram demonstrating bulbar urethral stricture.
Urethral strictures. Retrograde urethrogram demons Urethral strictures. Retrograde urethrogram demonstrating complete obliteration of the bulbous urethra.
Retrograde urethrogram demonstrating pan-urethral Retrograde urethrogram demonstrating pan-urethral stricture disease.
Urethral strictures. Retrograde urethrogram demons Urethral strictures. Retrograde urethrogram demonstrating patent urethra after buccal mucosa urethroplasty.
Urethral strictures. Retrograde urethrogram demons Urethral strictures. Retrograde urethrogram demonstrating patent urethra after excision of stricture and primary anastomosis.

An antegrade cystourethrogram involves distending the bladder with water-soluble contrast media via a suprapubic tube or urethral catheter. A scout film is taken before administration of contrast material. Once the bladder is fully distended with contrast media, the suprapubic tube is clamped or the urethral catheter is removed and the patient is asked to void. Spot films are taken before, during, and after the voiding phase. This study can help delineate the posterior urethral anatomy.

Ultrasonography of the male urethra can be useful in evaluating urethral strictures. A transducer can be placed longitudinally along the phallus, within the lumen of the urethra or along the perineum. Ultrasonography can be used to evaluate the stricture length and the degree and depth of spongiofibrosis. Several authors have described techniques that involve distension of the urethra with normal saline instilled in a retrograde fashion prior to ultrasonography. Ultrasonography demonstrates thicker periurethral tissues at the level of the stenosis compared to unaffected areas of the urethra. Ouattara et al (2004) showed that urethral strictures identified on perineal sonograms were significantly longer than those identified on retrograde urethrography and voiding cystourethrography.[6]

A study by Zhang et al evaluated patients with conventional voiding and retrograde urethrography and 64-row multidetector CT (64-MDCT) urethrography and found that 64-MDCT urethrography is a useful alternative to traditional radiographic methods for defining male urethral strictures.[7, 5]

Next

Diagnostic Procedures

Endoscopic evaluation can be conducted by flexible or rigid cystourethroscopy. Flexible cystourethroscopy can be performed with little discomfort to the patient using only local anesthesia, such as 2% lidocaine jelly intraurethrally.

Previous
 
 
Contributor Information and Disclosures
Author

Joshua A Broghammer, MD Assistant Professor, University of Kansas Medical Center

Joshua A Broghammer, MD is a member of the following medical societies: American College of Surgeons, American Urological Association, American Association of Clinical Urologists, Society of Genitourinary Reconstructive Surgeons

Disclosure: Received consulting fee from American Medical Systems for consulting.

Coauthor(s)

Richard A Santucci, MD, FACS Specialist-in-Chief, Department of Urology, Detroit Medical Center; Chief of Urology, Detroit Receiving Hospital; Director, The Center for Urologic Reconstruction; Clinical Professor of Urology, Michigan State University College of Medicine

Richard A Santucci, MD, FACS is a member of the following medical societies: American College of Surgeons, Societe Internationale d'Urologie (International Society of Urology), American Urological Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Bradley Fields Schwartz, DO, FACS Professor of Urology, Director, Center for Laparoscopy and Endourology, Department of Surgery, Southern Illinois University School of Medicine

Bradley Fields Schwartz, DO, FACS is a member of the following medical societies: American College of Surgeons, Society of Laparoendoscopic Surgeons, Society of University Urologists, Association of Military Osteopathic Physicians and Surgeons, American Urological Association, Endourological Society

Disclosure: Nothing to disclose.

Additional Contributors

Daniel B Rukstalis, MD Professor of Urology, Wake Forest Baptist Health System, Wake Forest University School of Medicine

Daniel B Rukstalis, MD is a member of the following medical societies: American Association for the Advancement of Science, American Urological Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous authors Jon Timothy Posey, MD; Angelo E Gousse, MD; and Daniel J Caruso, MD, MBA to the original writing and development of this article.

References
  1. Al Taweel W, Seyam R. Visual Internal Urethrotomy for Adult Male Urethral Stricture Has Poor Long-Term Results. Adv Urol. 2015. 2015:656459. [Medline].

  2. Odoemene CA, Okere P. One-stage Anastomotic Urethroplasty for Traumatic Urethral Strictures. January 2004-January 2013. Niger J Surg. 2015 Jul-Dec. 21 (2):124-9. [Medline].

  3. Liu JS, Hofer MD, Oberlin DT, Milose J, Flury SC, Morey AF, et al. Practice Patterns in the Treatment of Urethral Stricture Among American Urologists: A Paradigm Change?. Urology. 2015 Oct. 86 (4):830-4. [Medline].

  4. Parker DC, Simhan J. Management of complications after surgical outlet reduction for benign prostatic obstruction. Can J Urol. 2015 Oct. 22 (5 Suppl 1):88-92. [Medline].

  5. Song L, Xie M, Zhang Y, Xu Y. Imaging techniques for the diagnosis of male traumatic urethral strictures. J Xray Sci Technol. 2013. 21(1):111-23. [Medline].

  6. Ouattara DN, N'zi KP, Diabaté AS, Coulibaly N, Dédé NS, Yapo P, et al. Value of perineal ultrasonography for diagnosing anterior urethral strictures. J Rad. May 2004. 85:639-42. [Medline].

  7. Zhang XM, Hu WL, He HX, et al. Diagnosis of male posterior urethral stricture: comparison of 64-MDCT urethrography vs. standard urethrography. Abdom Imaging. 2011 Dec. 36(6):771-5. [Medline].

  8. Steenkamp JW, Heyns CF, de Kock ML. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol. 1997 Jan. 157(1):98-101. [Medline].

  9. Milroy E, Allen A. Long-term results of urolume urethral stent for recurrent urethral strictures. J Urol. 1996 Mar. 155(3):904-8. [Medline].

  10. Morey AF, Metro MJ, Carney KJ, et al. Consensus of genitourinary trauma: External genitalia. BJU Int. Mar 2004. 94:507-15. [Medline].

  11. Pansadoro V, Emiliozzi P, Gaffi M, Scarpone P. Buccal mucosa urethroplasty for the treatment of bulbar urethral strictures. J Urol. 1999 May. 161(5):1501-3. [Medline].

  12. DeLong J, Buckley J. Patient-reported outcomes combined with objective data to evaluate outcomes after urethral reconstruction. Urology. 2013 Feb. 81(2):432-6. [Medline].

  13. Barbagli G, De Angelis M, Romano G, Lazzeri M. Long-term follow-up of bulbar end-to-end anastomosis: a retrospective analysis of 153 patients in a single center experience. J Urol. Dec 2007. 178:2470-3. [Medline].

  14. Palminteri E, Berdondini E, De Nunzio C, Bozzini G, Maruccia S, Scoffone C, et al. The impact of ventral oral graft bulbar urethroplasty on sexual life. Urology. 2013 Apr. 81(4):891-8. [Medline].

  15. Dublin N, Stewart LH. Oral complications after buccal mucosal graft harvest for urethroplasty. BJU Int. 2004 Oct. 94(6):867-9. [Medline].

  16. Kluth LA, Dahlem R, Reiss P, Pfalzgraf D, Becker A, Engel O, et al. Short-term outcome and morbidity of different contemporary urethroplasty techniques - a preliminary comparison. J Endourol. 2013 Mar 14. [Medline].

  17. Shah DK, Paul EM, Badlani GH. North American Study Group. 11-year outcome analysis of endourethral prosthesis for the treatment of recurrent bulbar urethral stricture. J Urol. Mar 2003. 170(4 Pt 1):1255-8. [Medline].

  18. De Vocht TF, van Venrooij GE, Boon TA. Self-expanding stent insertion for urethral strictures: a 10-year follow-up. BJU Int. May 2003. 91(7):627-30. [Medline].

  19. Morgia G, Saita A, Morana F, et al. Endoprosthesis implantation in the treatment of recurrent urethral stricture: a multicenter study. Sicilian-Calabrian Urology Society. J Endourol. 1999 Oct. 13(8):587-90. [Medline].

  20. Jordan GH, Schlossberg SM. Surgery of the penis and urethra. Wein AJ, et al, eds. Campbell-Walsh Urology. 9th ed. Philadelphia, Pa: WB Saunders Co; 2007. Vol 1: 1023-97.

  21. Mundy AR. Management of urethral strictures. Postgrad Med J. Aug 2006. 82(970):489-9. [Medline].

  22. Angermeier KW, Jordan GH, Schlossberg SM. Complex urethral reconstruction. Urol Clin North Am. 1994 Aug. 21(3):567-81. [Medline].

  23. Wessells H, McAninch JW. Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction. World J Urol. 1998. 16(3):175-80. [Medline].

  24. Greenwell TJ, Venn SN, Mundy AR. Changing practice in anterior urethroplasty. BJU Int. Apr 1999. 83(6):631-5. [Medline].

  25. Coursey JW, Morey AF, McAninch JW, et al. Erectile function after anterior urethroplasty. J Urol. Dec 2001. 166(6):2273-6. [Medline].

  26. Dogra PN, Saini AK, Seth A. Erectile Dysfunction After Anterior Urethroplasty: A Prospective Analysis of Incidence and Probability of Recovery-Single-center Experience. Urology. 2011 Jul. 78(1):78-81. [Medline].

  27. El Kassaby AW, Abouschwareb T, Atala A. Randomized comparative study between buccal mucosal and acellular bladder matrix grafts in complex anterior urethral strictures. J Urol. April 2008. 179:1432-6. [Medline].

  28. Aboushwareb T, Atala A. Stem cells in urology. Nat Clin Pract Urol. 2008 Nov. 5(11):621-31. [Medline].

 
Previous
Next
 
Urethral strictures. Cross-sectional diagram of the penis.
Urethral strictures. Schematic of penile anatomy.
Retrograde urethrogram demonstrating bulbar urethral stricture.
Urethral strictures. Retrograde urethrogram demonstrating complete obliteration of the bulbous urethra.
Retrograde urethrogram demonstrating pan-urethral stricture disease.
Urethral strictures. Retrograde urethrogram demonstrating patent urethra after buccal mucosa urethroplasty.
Urethral strictures. Retrograde urethrogram demonstrating patent urethra after excision of stricture and primary anastomosis.
Urethral strictures. Photograph of a permanent urethral stent.
Urethral strictures. A buccal mouth graft has been harvested from the inner aspect of the cheek. The graft size is measured to accommodate the length of urethra involved in the onlay.
Urethral strictures. The buccal mucosal grafts have been secured to the corpora cavernosa. The anastomosis will run along either side of the dorsum of the urethral edges to complete the dorsal onlay. The glans penis (distal) is at the top of the picture. The catheterized urethra with a dorsal urethrotomy is on the left.
Urethral strictures. Photograph of open urethroplasty depicting the pedicled flap.
Urethral strictures. Photograph depicting pedicled flap anastomosed to the left side of the urethra. Suturing of the right side of the pedicled flap to the urethra completes the anastomosis.
Urethral strictures. The anastomosis of the pedicled flap is complete. The pedicle of the flap (left side) originates from the dorsolateral aspect of the penis. The glans penis (distal) is at the top of the photograph.
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.