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      Extent of spongiofibrosis and length of strictures: Findings at sonourethrography and urethroplasty

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          Abstract

          Introduction:

          The purpose of this study was to diagnose urethral stricture and to determine the extent of spongiofibrosis as well as the length of stricture using sonourethrography and compare it with intraoperative findings.

          Patients and Methods:

          It was a cross sectional observational study from September 2017-August 2018. All patients who presented with urethral stricture, scheduled for urethroplasty, and consented to the study were enrolled. The extent of spongiofibrosis and length of strictures were determined at sonourethrography and subsequently at urethroplasty. Sensitivity, specificity, positive predictive value and negative predictive values of sonourethrography in the determination of length of stricture was done. Spearman correlation coefficient(r) was used to describe the association between the extent of spongiofibrosis found at sonourethrography and at urethroplasty.

          Results:

          A total of 84 patients were evaluated during the study period. The median age at presentation was 45years. 81% of the patients had moderate spongiofibrosis on sonourethrography. There was a significant correlation of 71.4% between the extent of spongiofibrosis on sonourethrography and at urethroplasty. In evaluation for the length of strictures, sonourethrography had a sensitivity of 84.6% specificity of 82.7%, PPV of 68.7% and NPV 92.3%.

          Conclusion:

          Sonourethrography is a valuable tool in the evaluation of urethral strictures. Its radiation free readily available even in resource-poor settings and gives a good evaluation of extent of spongiofibrosis as well as the length of strictures. It's use in the preoperative evaluation of strictures may improve the outcome of the management of strictures.

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          Most cited references28

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          Urethral stricture: etiology, investigation and treatments.

          Urethral stricture is a narrowing of the urethra due to scar tissue, which leads to obstructive voiding dysfunction with potentially serious consequences for the entire urinary tract. Its prevalence among men in industrial countries is estimated at 0.9%. It produces obstructive and irritative urinary symptoms and can ultimately impair renal function. Urethral strictures can be caused by diagnostic or therapeutic urological procedures. These procedures are being performed ever more commonly, because the population is aging; thus, urethral strictures will probably become more common as well.
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            Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow-up

            Background Our objective is to report a comparative review of recently released guidelines for the evaluation, management, and follow-up of urethral stricture disease. Methods This is an analysis of the American Urologic Association (AUA) and Société Internationale d’Urologie (SIU) guidelines on urethral stricture. Strength of recommendations is stratified according to letter grade that corresponds to the level of evidence provided by the literature. Results Although few, the discrepancies between the recommendations offered by the two guidelines can be best explained by varying interpretations of the literature and available evidence on urethral strictures. When comparing the AUA guidelines and the SIU guidelines on urethral stricture, there are very few discrepancies. Perhaps the most notable difference is in the use of repeat DVIU or urethral dilation after an initial failed attempt. SIU guidelines state that there are instances where repeat DVIU or urethral dilation can be indicated, and they give a range of time at which stricture recurrence post procedure mandates an urethroplasty (less than 3 to 6 months). The AUA guidelines definitively state that repeat endoscopic procedures should not be offered as an alternative to urethroplasty, and they do not mention time of stricture recurrence as a factor. SIU guidelines allow for management of urethral stricture with indwelling urethral stenting. Conclusions Overall there is a need for more high quality research in the work up, management, and follow up care of urethral stricture.
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              Imaging of urethral stricture disease

              Accurate imaging of urethral strictures is critical for preoperative staging and planning of reconstruction. The current gold standard, retrograde urethrography (RUG), allows for accurate diagnosis, staging, and delineation of urethral strictures, and remains a cornerstone in the management of urethral stricture disease. In complex situations, the RUG can be combined with voiding cystourethrogram (VCUG) in order to better visualize the posterior urethra or complex distraction defects. Direct visualization of the stricture by cystoscopy, either retrograde or antegrade, can provide additional information as to the location and appearance of stricture, as well as precise location on fluoroscopic imaging. Sonourethrography (SU) is a useful adjunct to allow for three-dimensional assessment of stricture length and location, and can be a useful intraoperative assessment tool, however, its use remains limited to a second-line setting. Cross-sectional imaging in the form of computed tomography (CT) or magnetic resonance urethrography can provide additional three-dimensional information of anatomic structures and their relations, and can serve as a useful adjunct in complex clinical scenarios.
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                Author and article information

                Journal
                Urol Ann
                Urol Ann
                UA
                Urology Annals
                Wolters Kluwer - Medknow (India )
                0974-7796
                0974-7834
                Jan-Mar 2021
                04 November 2020
                : 13
                : 1
                : 41-46
                Affiliations
                [1]Division of Urology, Ahmadu Bello University, Zaria, Nigeria
                Author notes
                Address for correspondence: Dr. Nasir Oyelowo, Division of Urology, Ahmadu Bello University, Zaria, Nigeria. E-mail: nasiroyelowo@ 123456gmail.com
                Article
                UA-13-41
                10.4103/UA.UA_161_19
                8052901
                33897163
                23161381-a940-4d58-a3af-4b8c27fa59d9
                Copyright: © 2020 Urology Annals

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                : 29 November 2019
                : 19 June 2020
                Categories
                Original Article

                Urology
                spongiofibrosis,sonourethrography,urethroplasty,anterior urethral strictures
                Urology
                spongiofibrosis, sonourethrography, urethroplasty, anterior urethral strictures

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