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Is ascending urethrogram mandatory for all urethral strictures?

Syed Mamun Mahmud¹, Khalid Salman El, Abdul Majid Rana

¹The Kidney Centre Postgraduate Training Institute, Karachi.

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|October 1, 2008

Summary

Ascending urethrogram is not fully reliable for diagnosing urethral strictures, with a negative predictive value of 76%. Cystourethroscopy is recommended for accurate diagnosis and treatment planning.

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Area of Science:

Urology
Diagnostic Imaging

Background:

Urethral strictures cause lower urinary tract symptoms.
Accurate diagnosis is crucial for effective treatment.

Purpose of the Study:

To evaluate the diagnostic accuracy of ascending urethrogram for urethral strictures.
To determine its role in guiding treatment decisions.

Main Methods:

Retrospective review of 92 male patients with suspected urethral strictures.
Ascending urethrogram followed by cystourethroscopy in select cases.
Calculation of sensitivity, specificity, and predictive values.

Main Results:

Ascending urethrogram showed 91% sensitivity and 72% specificity for urethral strictures.
Positive predictive value was 89%, negative predictive value was 76%.
Discrepancies between imaging and cystourethroscopy were noted (P = 0.001).

Conclusions:

Ascending urethrogram has limitations in ruling out or confirming urethral strictures.
Cystourethroscopy is essential for definitive diagnosis and planning optical internal urethrotomy.
Cystourethroscopy avoids unnecessary procedures, radiation, and contrast reactions.