Compare the Diagnostic Accuracy of Sonourethrogram and Retrograde Urethrogram

Rajakumari, S N (2006) Compare the Diagnostic Accuracy of Sonourethrogram and Retrograde Urethrogram. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Stricture urethra is a very common urological disease. We perform on an average 12 Visual Internal Urethrotomies and one urethroplasty per month. Common Etiology being inflammatory anterior urethral strictures and post traumatic bulbomembranous strictures. The standard diagnostic modality we use is Retrograde urethrogram and Combined Cysto Urethrogram. Since sonography has become the urologist's stethoscope, we evaluated stricture urethra with sonourethrogram and compared sonourethogram to RGU, weighing the pros and cons of each. AIM: To compare the diagnostic accuracy of sonourethrogram and Retrograde Urethrogram. To find out the degree of spongiofibrosis by sonourethrogram. Application of doppler USG to locate the bulbourethral arteries in men with normal urethra and to study anatomical alterations in men with urethral stricture. Parameters that have a major influence on the selection of therapy in urethral stricture disease being exact length of stricture, its location, density and percentage narrowing of urethral lumen. Identifying the exact location of bulbourethral arteries could help avoid injury to the vessels during VIU. MATERIALS AND METHODS: Retrograde Urethrogram - 60% meglumine diatrizoate 10ml + 10 ml of normal saline was loaded in a 20cc syringe with a small cannula fixed to the nozzle, the tip of which was placed in the meatus contrast injected and overhead film exposure made with the patient in 45 degree oblique position, lying on either side and the dependent thigh acutely flexed. Sonourethrogram - High frequency linear array transducers 5 MHz and 7 MHz were used to evaluate the urethra. Images obtained in longitudinal and transverse planes by placing the probe on the ventral aspect of penis and perineum. The anterior urethra which passes through the length of penis is not visualized when collapsed, but it imaged when distended by retrograde injection of saline loaded in 20 cc syringe, the nozzle of which is placed in the meatus. With the tip of penis pinched manually. The flow of saline through the urethra was also observed during real time imaging. RESULTS: No.of cases studied - 50 cases. The parameters studied being length of stricture, degree of spongiofibrosis, percentage narrowing of urethral lumen. The results were correlated to urethroscopy - SPC scopy, VIU and urethroplasty findings of the same. Doppler USG localisation of bulbourethral arteries was done in 15 normal men and 15 men with urethral stricture. Out of 50 cases studied, Short bulbar strictures - 22 cases, Stricture of pendular and bulbar urethra - 15 case, Bulbomembranous stricture - 8 cases, Penile urethral stricture - 5 cases. Common etiologies are BXO, post bacterial urethritis sequalae, traumatic catheterisation or long-term indwelling catheters, perineal trauma, post TURP, unknown etiology. One case was associated with extensive GUTB. CONCLUSION: We believe that sonourethrogram is a very useful modality in the evaluation of anterior urethral strictures. It is superior to retrograde urethrogram in stricture length and spongiofibrosis assessment, which aid in choosing the ideal therapeutic approach. By preoperatively identifying bulbar strictures too long for resection and end-end anastamosis, we may plan for flap or graft procedure. Excision and end-end anastamosis may be planned for strictures appearing sonographically 25mm or less and substitution urethroplasty for longer strictures. Dense strictures as evidence by higher grade of spongiofibrosis and more than 75% luminal narrowing predict poor VIU outcome and in such stricture the bulbourethral arteries lie very close to the lumen and be a source of torrential bleed during VIU. Sonourethrogram is good for the patient for a number of reasons. Multiple examinations are often required in stricture cases and hence reduces exposure to radiation. The 3 dimensional nature of urethra can be appreciated on sonourethrogram which is a simple, convenient and rapid investigatory modality. Both cross sectional and longitudinal images can be easily obtained. The procedure is well tolerated by patients, who are protected from the allergic and anaphylactic reactions induced by iodinated contrast extravasation during RGU. Intraluminal filling defects including stones and growth FB, can be visualised by sonourethrogram . Subtle changes associated with urethritis are identifiable. Antegrade sonourethrogram may come to play a major role in post hypospadias repair cases, where placement of injection port in the neo-meatus may be difficult and descending SU may be more physiological. TRUS or trans vaginal sonar visualisation of urethra and bladder may play a major role in future in the evaluation of voiding dysfunction.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Diagnostic Accuracy ; Sonourethrogram ; Retrograde Urethrogram ; Comparative study.
Subjects: MEDICAL > Urology
Depositing User: Kambaraman B
Date Deposited: 12 Oct 2017 01:07
Last Modified: 12 Oct 2017 01:07
URI: http://repository-tnmgrmu.ac.in/id/eprint/3428

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