Pre-operative Assessment by Sonourethrography Only in Anterior Urethral Strictures.
Pre-operative Assessment by Sonourethrography Only in Anterior Urethral Strictures.
The choice of the best surgical technique for urethral stricture repair depends on the
 stricture length. Estimating the length of urethral strictures is therefore of utmost
 importance.

 Different clinical studies have proven that SUG has a higher sensitivity to evaluate the
 length of urethral strictures compared to RUG or VCUG.

 The goal of this study is to assess the feasibility of using SUG as single pre-operative
 assessment tool in patients with suspicion of anterior urethral strictures. In this way, use
 of RUG and/or VCUG could be omitted in the pre-operative work-up of patients with anterior
 urethral strictures, thereby avoiding significant radiation load of patients.
Urethral stricture disease (USD) is a medical condition in which a narrowing of the urethral
 lumen occurs due to pathological fibrosis and cicatrix formation of the urethral mucosa and
 surrounding spongious tissue (spongiofibrosis). Urethral strictures may occur at any location
 from the bladder neck to the external urethral meatus and are categorized based on their
 localisation in anterior strictures (including the urethral meatus, penile urethra and bulbar
 urethra) and posterior strictures (including the prostatic urethra and membranous urethra).
 USD is a disease of all ages but the prevalence increases with increasing age since the
 cumulative risk of having had urethral instrumentation equally increases. All processes that
 cause urethral trauma may provoke USD. The majority of strictures nowadays is idiopathic or
 caused by iatrogenic trauma of the urethra.

 The pathological narrowing of the urethral lumen can lead to a wide variety of symptoms which
 ask for specific diagnostic investigations, in which imaging of the urethra plays a central
 role. Retrograde urethrography (RUG) and voiding cystourethrography (VCUG) are considered to
 be the gold standard diagnostic investigation techniques for diagnosis of USD.

 In both techniques, contrast is instilled in the urethra through the urethral meatus and
 radiographic imaging is used to visualize the urethra. RUG and VCUG offer the possibility to
 visualize the urethra completely and to evaluate the number, length and location of urethral
 strictures. On the other hand, these techniques have some crucial disadvantages. First and
 foremost, the radiation load of the genitopelvic region in often young patients is inevitable
 in RUG and VCUG. Secondly, it is impossible to evaluate the degree of spongiofibrosis with
 radiographic imaging.

 In 1988, McAnnich, et al. were the first to describe sonourethrography (SUG) for the
 diagnosis of anterior urethral strictures in males. In this technique, a Foley catheter is
 inserted in the urethral meatus and a physiological solution is instilled in the urethra
 while a linear 7,5 MHz ultrasound probe is placed sagitally over the course of the urethra.
 SUG is not only able to evaluate the length and localization of a US, but it also enables the
 investigator to evaluate the grade of spongiofibrosis.

 Different strudies have shown that SUG has a higher sensitivity for the measurement of
 urethral stricture length compared to classical radiographic imaging such as RUG or VCUG.
 Since the choice of the most adequate surgical technique depends on the length of the
 urethral stricture, correct estimation of the urethral stricture length is of the utmost
 importance.

 The goal of this study is to evaluate the feasibility of the use of sonourethrography as
 single diagnostic tool in the pre-operative diagnostic work-up of males with suspicion of
 anterior urethral strictures. In this way, classic radiographic imaging such as RUG and VCUG
 could be omitted in these patients, saving them from a significant radiation load.
Inclusion Criteria:

 -  Age: 18 years or older

 -  Anterior urethral strictures (except for meatal strictures)

 Exclusion Criteria:

 -  Posterior urethral strictures

 -  Meatal strictures

 -  History of hypospadias repair

 -  History of phalloplasty