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Clinical Presentation and Diagnostic Evaluation of Male Urethral Stricture

  • Alvaro A. Saavedra
  • Keith F. RourkeEmail author
Chapter
First Online:

Abstract

Primary diagnosis of urethral strictures mostly relies on the presence of certain risk factors in the context of bladder outlet obstruction, that lead to further investigation. Findings on physical examination, patient-reported assessments, uroflowmetry, and post-void residual determination can raise suspicion of a stricture, but are not sufficient for diagnostic confirmation. Definitive diagnosis of urethral narrowing is based on cystoscopy, while staging, characteristics determination, and surgical planning is typically made using retrograde/voiding urethrogram. Evidence supporting the use of urethral ultrasound for anterior strictures has been growing considerably and may be even considered as surrogate for urethrogram in some specific settings. More recently, both urethral magnetic resonance, along with urethral computed tomography have proven to be helpful for complex cases of pelvic fracture urethral injuries, fistulas, and posterior urethral strictures.

Regarding follow-up studies after surgical repair, it has been recommended to use periodical patient-reported outcome measurements including not only voiding features, but also sexual, overall satisfaction, and quality of life fields, since, besides voiding function, urethroplasty may impact on several aspects of patients’ daily life. Currently, a comprehensive tool incorporating all these aspects does not exist yet. Additionally, uroflowmetry and post-void residual measurement should be performed on a regular basis. Nonetheless, cystoscopic evaluation should be done around 3 months and between 12 and 18 months postoperatively, because some recurrences may not be detected by the above-mentioned assessments. If a stricture recurrence is detected, then urethrogram is mandatory for staging and further surgical planning.

Keywords

Urethral stricture/diagnosis Urethra/diagnostic imaging Urethroplasty Cystoscopy Patient reported outcome measures Urethral diseases Urethrogram Tomography X-ray computed Magnetic resonance imaging Ultrasonography Quality of life 
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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Division of Urology, Department of SurgeryUniversity of AlbertaEdmontonCanada
  2. 2.Urology Department, Division of Surgery, Faculty of MedicineP. Universidad Católica de ChileSantiagoChile
  3. 3.Urology ServiceDr. Sotero del Rio HospitalPuente AltoChile

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