urethral stricture

Penile trauma
- Corpus spongiosum tear. Coronal view: - Yellow arrows: Penile bulb / - Red arrows: anterior extension of contrast within corpus spongiosum / - Orange arrow: Urethral extension of contrast. Normal penile anatomy: Corpus cavernosus (green arrows), corpus spongisoum (black arrow).
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Urethral
stricture • Urethral stricture with venous intravasation, Christmas tree bladder and vesicoureteral reflux - Ganzer Fall bei Radiopaedia
Niknejad, M. Urethral stricture with venous intravasation, Christmas tree bladder and vesicoureteral reflux. Case study, Radiopaedia.org. (accessed on 08 Nov 2022) https://doi.org/10.53347/rID-91233 • CC by-nc-sa 3.0 (modified)
Teenager with
straining with urination. Oblique image from a retrograde urethrogram shows a fixed, marked narrowing in the bulbar urethra.The diagnosis was bulbar urethral stricture.
pediatricimaging.org • CC-by-nc-sa 4.0
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Radiopaedia • CC-by-nc-sa 3.0 • de

Urethral strictures are relatively common and typically occur either in the setting of trauma or infection.

Epidemiology

The demographics of the affected population is dictated by the etiology, but in general, it is safe to say that adult males make up the vast majority of cases.

Clinical presentation

The primary mode of presentation of a symptomatic stricture is with poor urinary stream. If severe, bladder hypertrophy and trabeculation may occur.

Pathology

In general, the term urethral stricture refers to a fibrous scarring of the anterior urethra caused by collagen and fibroblast proliferation.

Etiology

Common causes of urethral strictures include:

  • infection
    • gonococcal urethritis (more common)
    • non-gonococcal urethritis (less common)
  • inflammatory
    • balanitis xerotica obliterans
  • trauma
  • iatrogenic
  • congenital

Although gonorrhea remains the most common sexually transmitted disease, urethral strictures are far less common than previously due to early treatment.

Instrumentation-related strictures usually occur in the bulbomembranous region and, less commonly, at the penoscrotal junction.

Radiographic features

Radiographic evaluation helps define the location, length, number, and degree of strictures.

Fluoroscopy

Retrograde urethrography is the primary method used to image anterior urethral stricture.

In posterior urethral strictures following blunt trauma, simultaneous antegrade cystourethrography and retrograde urethrography are often required to determine the length of the urethral defect.

Ultrasound

Sonourethrography is best used adjunctively to guide treatment planning in patients with known bulbous urethral strictures and has been reported to be more accurate than retrograde urethrography for estimating the length of urethral strictures.

In pediatric cases, it worth using ultrasound instead of x-rays and CT to reduce dose to the patient, although this may be a challenging test due to lack of cooperation.

MRI

MR imaging is considered to be the best ancillary imaging modality for assessing post-traumatic pelvic anatomy.

Treatment and prognosis

Treatment options include urethral dilation, internal urethrotomy, or permanent urethral stenting.

Practical pearls and pitfalls

Urethral strictures should not be confused with physiologic narrowing of the lumen at the level of membranous part of the urethra.

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Harnröhrenstriktur:
Urethra
 
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Urethralklappe
 
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Divertikel
der Urethra
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Urethrographie
 
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