Sudhakar, V (2013) Role of MR Urethrography Compared to Conventional Urethrography (Retrograde Urethrography and Opposing Urethrography) in the Surgical Management of Obliterative Urethral Stricture. Masters thesis, Madras Medical College, Chennai.
|
Text
200800113sudhakar.pdf Download (1MB) | Preview |
Abstract
Imaging of the urinary tract with radiographs and contrast media played important role in the diagnosis of disorders of urinary tract for decades. After the discovery of X-ray beam by Roentgen, the first image of a renal calculi was acquired by John Macintyre. Radiography alone was not definitively adequate to image the urinary system. The first “opacification” of the ureter, was indeed done by Tuffier T.Sonde. He inserted a metal wire into a ureteral catheter to opacify it. The metal wire, subsequently was replaced by radio opaque ureteral catheters. Following this, air had been injected as a contrast media to image the ureter which soon was again replaced by liquid contrast media consisting silver colloid. The first ever retrograde pyelogram was done by Voelcker F,Von Lichtenberg. Though its usefulness was proven, the dangers associated with the silver-containing contrast agents quickly recognized. Therefore search for safer contrast materials began. Cameron in 1918 first described Sodium iodide solutions, which was considered became the contrast media of choice in doing retrograde pyelography. CONCLUSION : Conventional retrograde urethrography and Opposing urethrography were well known established techniques in delineating urethral strictures both and posterior. These modalities although readily available and cost effective do not determine the accurate length and periurethral fibrosis. Furthermore, if the patient cannot relax the bladder neck the length of stricture can be grossly overestimated in a case of posterior urethral stricture. The anterior urethral stricture may be underestimated due to problems of positioning. These studies also requires adequate degrees of renal function for contrast excretion, the need for administration of potentially risk contrast media, the relatively significant amount of radiation exposure especially in younger patients. MR Urethrography can be a valuable means of imaging patients with urethral strictures. T2 weighted sequences are excellent for demonstrating urethra as well as rest of urinary system. MR imaging is especially useful in planning the surgical procedure in cases of posterior urethral strictures with displacement the prostatic apex due to pelvic trauma. It also determines the avulsion of corpus cavernosum from the ischaemia which result in impotence . It accurately shows the stricture length and prostatic apical displacement and dictataes the surgeon to plan the surgery via the perineal (or) transpubic approach. A combined perineal and transpubic approaches may be needed in larger defects measuring more than 6 cm with extensive suprolateral displacement. It also plays important role in the surgical treatment of anterior urethral strictures by accurate measurement of the stricture length and associated periurethral fibrosis. In this condition only strictures upto 1.5 cm are amenable for endoscopic urethrotomy. Even with these short strictures extensive periurethral fibrosis precludes dilatations and endoscopic urethrotomy requiring primary anastomotic urethroplasty. MRU can be successfully performed in patients in whom contrast studies are contraindicated. Paediatric population can also be subjected to MRU without radiation to testis. From our study, it is evident that MR Urethrography depicts stricture length, periurethral fibrosis, displacement of the prostatic apex and also associated pathologies with accuracy, there by assisting the surgeons to the select most appropriate surgical procedure for the patients with oblitrative urethral stricture.
| Item Type: | Thesis (Masters) |
|---|---|
| Uncontrolled Keywords: | Mr Urethrography ; Compared ; Conventional Urethrography ; Retrograde Urethrography ; Opposing Urethrography Surgical Management ; Obliterative Urethral Stricture. |
| Subjects: | MEDICAL > Radio Diagnosis |
| Depositing User: | Subramani R |
| Date Deposited: | 30 Jun 2017 15:25 |
| Last Modified: | 30 Jun 2017 15:25 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/751 |
Actions (login required)
 |
View Item |
