Evaluation of non-invasive tests as diagnostic tools in assessment of bladder outlet obstruction severity in men with anterior urethral stricture.

INTRODUCTION: The aim of this article was to evaluate non-invasive tests, which were typically used in preoperative diagnosis of male patients with anterior urethral strictures in the assessment of the urethral resistance caused by urethral occlusion. MATERIAL AND METHODS: A total of 63 adult males with confirmed urethral stricture and aged below 55 years old were enrolled in the study. Data obtained from non-invasive tests such as uroflowmetry (UF), ultrasound examination (USG), and questionnaires such as from The International Prostatic Symptom Score (IPSS), and The Patient-Reported Outcome Measure for Urethral Stricture Surgery (USS-PROM) were analyzed. RESULTS: Among all analyzed non-invasive tests, bladder wall thickness (BWT) showed the highest correlation with the degree of urethral occlusion described as percentage of preserved urethral lumen (r = -0.70; p <0.0001). UF variables presented medium degree of correlation, with maximum flow rate (Qmax) as the best parameter (p = 0.45; p = 0.0005). Results from both questionnaires did not show any correlation with the severity of the urethral stricture. Multiple linear regression analysis showed that only BWT was an independent predictor in detection degree of urethral occlusion. CONCLUSIONS: UF and USG seem to be useful additional diagnostic tools in assessment severity of urethral occlusion in men suffering from anterior urethral stricture. Among them, USG had the highest correlation with degree of urethral occlusion.

The impact of post-urethroplasty erectile dysfunction on the quality of life and treatment satisfaction.

INTRODUCTION: The aim of this article was to assess the influence of sexual disorders after urethroplasty on patient's quality of life (QoL) and satisfaction of treatment. MATERIAL AND METHODS: We studied 106 sexually active patients who underwent urethroplasty due to urethral stricture. Patients completed the Urethral Stricture Surgery - Patient Reported Outcome Measure (USS - PROM) and International Index of Erectile Function (IIEF-5) questionnaires before and after the treatment. Spearman rank correlations were used for correlation analyses. Multiple linear regression and ordinal logistic regression analyses were used for evaluating the influence of lower urinary tract symptoms (LUTS) and IIEF-5 scores on EuroQol-5D (EQ-5D) index, EuroQol-Visual Analogue Scale (EQ-VAS), and satisfaction with treatment. Both LUTS and IIEF-5 scores were independent, significant predictors of EQ-VAS in the multiple linear regression model. RESULTS: Mean follow-up was 9 months (3-24). Reduction of LUTS and micturition improvement in the USS-PROM questionnaire after the surgery was found in 90 patients (85%). The average IIEF-5 score in the whole group did not change significantly, but in 39 cases (37%) worsened, and in 42 (39%) improved. Spearman's rank-order correlation indicated a significant positive correlation between improvement in IIEF-5 and general QoL in EQ-5D and also a positive correlation between improvement in IIEF-5 and improvement in EQ-VAS, which was also statistically significant (rho = 0.377, p <0.001). CONCLUSIONS: Urethral surgery can influence sexual performance. The appearance of sexual dysfunction negatively affects the patient's quality of life, regardless of the effective restoration of the urethral patency and reduction of LUTS.

MRI in patients with urethral stricture: a systematic review.

Magnetic resonance imaging (MRI) is gaining acceptance as a diagnostic tool in urethral stricture disease. Numerous publications emphasize on the advantages of MRI including its ability to determine periurethral spongiofibrosis, thus overcoming the main limitation of retrograde urethrography (RUG). It is also becoming an alternative for sonourethrography (SUG), which is a highly subjective examination. Magnetic resonance urethrography (MRU) has become an increasingly appreciated tool for diagnosing patients with urethral stricture disease. Obtained data provides radiologists and urethral reconstructive surgeons with additional information regarding anatomical relationships and periurethral tissue details, facilitating further treatment planning. Considering the great prevalence of urethral stricture disease and necessity of using accurate, and acceptable diagnostic method, this review was designed to provide radiologists and clinicians with a systematic review of the literature on the use of MRI in the urethral stricture disease.

Ultrasonographic assessment of male anterior urethra. Description of the technique of examination and presentation of major pathologies.

During the last years the role of sonourethrography (SUG) in the assessment of anterior male urethra pathologies, has significantly increased. The investigation is easily performed, not time consuming and should be considered the imaging technique of choice for preliminary diagnosis, without exposing the patient to X-rays. In this paper we present the technique of examination and the most common pathologies in which SUG is indicated.

Primary urethral carcinoma - unexpected cause of urethral stricture. Case report and review of the literature.

Primary cancer of urethra (PCU) is one of rarest malignancies of the urinary tract. In early stages this type of cancer presents non specific symptoms which can be mistaken with more common urethral strictures. That is why the PCU is frequently recognize in a locally advanced stage. The basic tool used in the diagnosis is MRI, but ultrasonography can be also used at the beginning of diagnosis. We present the case of 66-year old patient with PCU, initially diagnosed due to urethral stricture. We report probably the first case of well documented sonourethrography findings in PCU.

Can ultrasonography be useful in the diagnosis of urethral disorders of female-to-male transsexuals?

Sonourethrography (SUG) is one of the basic imaging tools in the diagnosis of male anterior urethral strictures. So far, no one has described the use of this examination in transgender patients after "female-to-male" operation. Based on the presented case, we describe ultrasonographical features of the construction of a neophallus and offer information allowing a more accurate evaluation of urethral disorders in this group of patients.

Evaluation of outcomes of Urethral Stricture Surgery: psychometric validation of a Polish language version of the Patient-Reported Outcome Measure for urethral stricture surgery.

INTRODUCTION: The aim of this study is to validate the Polish version of the Urethral Stricture Surgery - Patient-Reported Outcome Measure (USS-PROM) by evaluating its psychometric properties. MATERIAL AND METHODS: Patients with urethral stricture scheduled for urethroplasty between 2014 and 2018 were prospectively enrolled. The results of the USS-PROM were obtained before the operation, and during follow-up visits. The original USS-PROM was translated into Polish and re-translated into English in accordance with the guidelines by Dawson et al. regarding the adaptation process. Psychometric assessment included internal consistency, test-retest reliability, criterion validity and responsiveness. RESULTS: One hundred twelve patients were included. 54 patients completed the USS-PROM both before and 3 months after the surgery and 39 of them completed the questionnaire 6 months after the surgery to evaluate the test-retest reliability. Cronbach's α for internal consistency of the lower urinary tract symptoms (LUTS) domain score was 0.87. The test-retest intraclass correlation coefficient was 0.82. Spearman's coefficients showed no correlation between USS-PROM's result and maximal urinary flow (Qmax) result before the surgery (rs = 0.13; p >0.05) and a positive correlation between USS-PROM's result and Qmax result at follow up: 3 months after (rs =- 0.56; p <0.05), 6 months after (rs -0.64; p <0.05), and 12 months after (rs = -0.85; p <0.05). There were statistically significant strong and positive correlations between LUTS score and International Prostate Symptom Score (IPSS). Responsiveness of the test was confirmed with non-parametric Friedman's analysis of variance (ANOVA) with Kendall's coefficient of concordance (χ2 ANOVA = 8.95, p = 0.03). CONCLUSIONS: The Polish version of the USS-PROM questionnaire has appropriate psychometric properties and can be used in the assessment of patients with urethral stricture undergoing urethroplasty.

Erectile dysfunction after urethroplasty.

INTRODUCTION: The aim of this study was to analyze the influence of urethroplasty on sexual function. MATERIAL AND METHODS: We analyzed 75 operations: 41 anastomotic, 13 labial graft, 6 thigh skin mesh graft, and 15 penile skin flap urethroplasties. The severity of erectile dysfunction was assessed in the International Index of Erectile Function (IIEF5) questionnaire, preoperatively and at least 3 months after the surgery. The appearance of possible penile deformities was also evaluated postoperatively. RESULTS: The etiology and location of the stricture had no impact on the erectile dysfunction in men with untreated urethral stricture. The difference in mean IIEF5 score before and after the first urethroplasty was not statistically significant (12.58 ±9.01 and 10.88 ±9.28; t(42) = 1.25, p = 0.220). The length of the stricture had no impact on the preoperative and postoperative IIEF5 score. Stricture in penile urethra caused a risk of postoperative penile curvature (p = 0.023). CONCLUSIONS: Patients with urethral stricture have a higher rate of erectile dysfunction than healthy men. Proper therapy should not negatively affect erectile function in a significant way, regardless of the length or location of the stricture, though it may have some influence on the penile anatomy.

Comparison between cystourethrography and sonourethrography in preoperative diagnostic management of patients with anterior urethral strictures.

AIM: To evaluate the urethral lesions and the degree of spongiofibrosis using cystourethrography (CUG) and sonourethrography (SUG) in order to propose the best imaging method for further surgical treatment. MATERIAL AND METHODS: The study involved 66 patients with anterior urethral strictures with indication for urethroplasty. Results of CUG and SUG were compared with each other and data from surgical protocol. RESULTS: Totally 72 strictures were detected; 47 in the bulbar part of urethra and 25 in the penile urethra. The mean length of the stenosis was 16.43 mm for CUG and 27.41 mm for SUG and 31.05 mm during surgery. The correlation levels between imaging techniques and intraoperative measurements were 0.55 (p<0.001) for CUG and 0.73 (p<0.001) for SUG. After dividing the strictures according to their location, better correlation for stenoses was obtained in penile urethra: 0.66 (p<0.001) for CUG and 0.86 (p<0.001) for SUG. CONCLUSIONS: SUG seems to be a simple and fast examination to evaluate urethral strictures. It is more accurate in comparison to CUG and gives a possibility to assess the spongiofibrosis. This information suggests that SUG can be a good complement to CUG in diagnosis of anterior urethtral strictures.