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Comparison of ultrasonography imagings and pathological findings in bulbar urethral strictures: a preliminary report.

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Sources of Funding: None

Introduction

We investigated the role of ultrasonography imaging and whether or not it correlates with the pathological findings in bulbar urethral strictures. We tested the hypothesis that urethral ultrasonography is a reliable non-invasive tool for spongiofibrosis staging in bulbar urethral stricture diseases.

Methods

This is a prospective study of 35 patients, mean age of 43 years (range 18-79), with bulbar urethral strictures who underwent urethroplasty from January 2016 to June 2016. All the patients were preoperatively evaluated by urethral ultrasonography. The operator was requested to mark the following 3 points: a) the normal urethra; b) the most fibrotic site of spongiofibrosis; c) 1 cm distally and proximally to the spogiofibrotic site. The urethral ultrasonography was repeated intra-operatively and these 3 points were clearly identified by inserting a small needle before to open the bulbar urethra. The urethra was ventrally opened and biopsies were taken according to the needles positions: 2 in the normal urethra distally and proximally to the fibrotic site, 2 biopsies were taken at 1 cm distally and proximally to the most fibrotic site and 1 biopsy was take from the fibrosis area. Controls were represented by samples of normal urethra and periurethral tissue collected from male-to-female trans-sexual surgery. A single expert pathologist evaluated all the biopsies. The primary end point of the study was to correlate the imaging with the pathological examination.

Results

In the stenotic area, which was marked as “fibrosis� at the ultrasonography, the pathological examination of the area showed squamous metaplasia of the epithelium characterized by hyperkeratosis and acanthosis. In the lamina propria, marked fibrosis without inflammation was also evident in all patients. In the segment 1 cm proximal to the stenotic area pathological examination showed squamous metaplasia of the epithelium characterized by hyperkeratosis and acanthosis. In the lamina propria, mild fibrosis without inflammation was observed. In the segment 1 cm distal to the stenotic area the pathological examination showed squamous metaplasia of the epithelium characterized by hyperkeratosis and acanthosis. In the lamina propria, mild fibrosis and mild inflammation were observed. Two cm distal to the stenotic area we found a normal columnar and stratified epithelium and no inflammation or fibrosis were observed in the lamina propria. A normal epithelium was found in all the controls.

Conclusions

Our findings revealed chronic abnormalities in the urethral ends of all patients far from the stenotic area. An interesting observation was the normal urethra at imaging showed morphological alterations at the pathological examination, revealing that ultrasonography may fail to identify the true extension of stricture disease. However, further studies are mandatory before we can accept the clinical introduction of ultrasonography in staging pathological extension of fibrosis in patients with bulbar urethral stricture.

Funding

None

Authors
Guido Barbagli
Rosario Caltabiano
Sofia Balò
Salvatore Sansalone
Carla Loreto
Massimo Lazzeri
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