Introduction

Accurate radiographic assessment of urethral stricture length relies on both a retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG). In men with high-grade strictures (very tight, very long or inflammatory strictures), it may be necessary to place a suprapubic cystostomy catheter (SPC) prior to urethroplasty in order to obtain accurate imaging. Using a panel of reconstructive surgeons to read the RUG/VCUGs, we sought to compare radiographic assessment of stricture length to intra-operative measurement in a cohort of men with SPC for high-grade stricture.

Methods

We queried our prospectively maintained urethroplasty database at the University of Minnesota for men with anterior urethral stricture and an SPC at the time of RUG/VCUG (n=49). To minimize responder fatigue, 20 pairs of radiographs were selected at random. All images were interpreted by eleven fellowship-trained reconstructive urologists. A single surgeon performed all reconstructions, during which, stricture length was noted. A two-tailed t-test was used to compare means between interpreted and observed lengths. Interclass correlation evaluated homogeneity amongst urologists. Linear regression analysis was performed to determine the association between observed stricture length and radiographic interpretation.

Results

Agreement among interpreting urologists was satisfactory with interclass correlation of 0.72. Of 20 identified patients, mean interpreted and observed stricture lengths were 3.8 cm (range 1-11) and 4.65 cm (range 1-14), respectively (p<0.0001). Deviation between interpreted and observed lengths increased with stricture length with a slope of 0.26cm (for every 1 cm increase in stricture length, deviation between interpreted and observed lengths increased by 0.26 cm) (p=0.0023, Fig. 1).

Conclusions

Despite optimal urethral imaging with an SPC in men with high-grade stricture, reconstructive urologists significantly underestimate the length by almost 1 cm; this underestimation increases with stricture length. This information may be useful for operative planning as decision making hinges upon accurate assessment of stricture length. Additionally, this information may impact consideration of endoscopic management of strictures that appear short on imaging.

Funding

none