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Inter-rater reliability of retrograde urethrograms.

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Urologist interpretation of retrograde urethrograms (RUGs) for urethral stricture disease shows poor to moderate reliability. Standardized RUG interpretation is needed to improve surgical planning and patient management.

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Area of Science:

  • Urology
  • Radiology
  • Surgical Planning

Background:

  • Pre-operative testing is crucial for effective surgical planning in urethral stricture disease.
  • Retrograde urethrogram (RUG) is a common pre-operative imaging modality.
  • Urologists often interpret RUGs themselves, necessitating an evaluation of their reliability.

Purpose of the Study:

  • To assess the reliability of retrograde urethrogram (RUG) interpretation among urologists at an institution.
  • To evaluate inter-rater agreement for RUG interpretations concerning stricture characteristics.

Main Methods:

  • 193 de-identified RUGs were interpreted by two general urologists and one reconstructive urologist (gold standard).
  • Inter-rater reliability was assessed by comparing general urologists to the gold standard and to each other.
  • Statistical analysis included intraclass correlation coefficient (ICC) and Cohen's Kappa (κ) for quantitative and categorical variables, respectively.

Main Results:

  • Agreement levels for RUG interpretation ranged from poor to moderate across all assessed variables.
  • Comparison of general urologists to the gold standard showed only moderate agreement, with most falling into poor to fair categories.
  • Agreement among general urologists also did not exceed moderate levels, with most results indicating poor to slight agreement.

Conclusions:

  • This study reveals clinically unacceptable inter-rater reliability in RUG interpretations for stricture length, location, caliber, and indicated procedures.
  • Findings highlight a critical need for standardized interpretation protocols for RUGs in managing urethral stricture disease.
  • There is a significant opportunity for improvement in the clinical management of urethral strictures through enhanced RUG interpretation consistency.