ROLE OF PREOPERATIVE SONOURETHROGRAPHY IN BULBAR URETHRAL RECONSTRUCTION

Purpose: The accuracy of sonourethrography for the evaluation of bulba r urethral strictures has been well documented. Thus, we sought to def ine the role of preoperative sonourethrography in establishing objecti ve criteria for procedure selection during bulbar urethral reconstruct ion. Materials and Methods: Sononrethrography was performed preoperati vely, just before incision, in 67 men selected for bulbar urethroplast y. All patients had strictures 25 mm. or less in length on preoperativ e radiographic retrograde urethrography, thus potentially amenable to resection and end-to-end anastomosis. Ultrasonic measurements were pro spectively recorded, compared with those can preoperative retrograde u rethrography, and used to guide the selection of urethroplasty techniq ue. Results: Overall, a significant trend for retrograde urethrography to underestimate stricture length was demonstrated (r = 0.678, p <0.0 001). Indeed, sonographic measurements were frequently twice those of retrograde urethrography, occasionally more. All 26 patients with shor t strictures on retrograde urethrography (10 mm. or less) were success fully treated by resection and end-to-end anastomosis, and sonographic assessment did not alter management. However, ultrasonic measurement changed the reconstructive procedure selected in 15 of 41 patients (37 %, 3 penile flaps, 12 graft procedures) with bulbar strictures of inte rmediate length on retrograde urethrography (11 to 25 mm.). Conclusion s: Sonourethrography has a major influence on selection of therapy in patients with bulbar strictures of intermediate length. By prospective ly identifying. strictures too long for resection and end-to-end anast omosis, sonourethrography enables quantitative criteria for selection of patients who may be more appropriately treated by flap or graft pro cedures. We advocate excisional therapy for strictures appealing sonog raphically to be 25 mm. or less, and substitution urethroplasty for lo nger strictures.