Role of Sonourethrographic Measurement of Severity of Spongiofibrosis in Predicting the Outcome of Visual Internal Urethrotomy in Short Bulbar Urethral Strictures
BAUS ePoster online library. Lalgudi D. Jun 26, 2019; 259502; P13-8 Disclosure(s): I have no such relationships to disclose
Dorairajan Narayanan Lalgudi
Dorairajan Narayanan Lalgudi
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Abstract
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INTRODUCTION:
To assess the predictive value of sonourethrographic measurement of severity of spongiofibrosis in short bulbar urethral stricture disease (USD) on the outcome of visual internal urethrotomy (VIU).

Patients and Methods:

Consenting patients from July 2016 to February 2018 with short (<2.5 cm) bulbar USD diagnosed on retrograde urethrogram (RUG) were studied using sonourethrography (SUG) prior to VIU. Data recorded included measurements of stricture length in RUG, SUG and VIU, minimum stricture calibre in RUG, percentage luminal encroachment using RUG (PLE-RUG), and depth (DSF-SUG) and relative depth (RDSF-SUG) of spongiofibrosis using SUG. After VIU the patients were followed up three monthly for at least six months by uroflowmetry and/or calibration. Failure was defined as inability to calibrate with 16F Foley catheter.

RESULTS:

A significant strong correlation (p<0.001) was found in stricture length measurement between RUG and SUG (R=0.99) and with length measured at VIU. VIU failed in five patients. Peak flow rate at 6 months (PFR) most strongly correlated with, and failure of VIU was associated with, stricture length, PLE-RUG and RDSF-SUG. On multiple regression analysis only RDSF-SUG had a significant association with PFR. On ROC analysis cut-off values for stricture length at 19.5mm and RDSF-SUG of 90.5% had an 80% sensitivity, and 91% and 85% specificity respectively, for predicting the success of VIU.

CONCLUSIONS:

Preoperative sonourethrographic measurement of relative depth of spongiofibrosis predicts failure of VIU, independent of stricture length, in patients with short bulbar USD. Patients with RDSF-SUG > 90% may be considered for urethroplasty rather than VIU.
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