Static MRI for diagnosis of bulbous urethral strictures and assessment of spongiofibrosis grade

Introduction. Insufficient sensitivity and specificity of existing methods for diagnosing urethral stricture require more accurate methods, which may include magnetic resonance imaging (MRI).

Objective. To study the possibilities of MRI to assess the extent of bulbous urethral stricture and spongiofibrosis grade.

Materials & methods. The study included six men with bulbous urethral stricture, who underwent non-transecting anastomotic urethroplasty via ventral approach. Before surgery, all patients underwent retrograde urethrography according to the standard method and urethral MRI according to their own method, and their data were compared with intraoperative parameters.

Results. The length of the stricture according to retrograde urethrography averaged 11.5 ± 6.3 mm, MRI — 17.8 ± 10.9 mm, intraoperative measurement — 16.7 ± 9.1 mm. There was a significant difference between the mean length of the stricture according to retrograde urethrography and the mean length according to intraoperative data (p = 0.028). There was no significant difference between the mean stricture length according to MRI data and the mean stricture length according to intraoperative data (p = 0.085). The length of spongiofibrosis according to MRI was 15.8 ± 13.6 mm on average, and 16.7 ± 12.9 mm according to intraoperative measurements. There was no significant difference between the average length of spongiofibrosis according to MRI and the average length according to intraoperative data (p = 0.092).

Conclusions. MRI provides information comparable to intraoperative data on the extent of urethral stricture, location, and spongiofibrosis grade.

1. Santucci RA, Joyce GF, Wise M. Male urethral stricture disease. J Urol. 2007;177(5):1667-74. DOI: 10.1016/j.juro.2007.01.041

2. Alwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014;3(2):209-13. DOI: 10.3978/j.issn.2223-4683.2014.04.07

3. Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L. Contemporary urethral stricture characteristics in the developed world. Urology. 2013;81(1):191-6. DOI: 10.1016/j.urology.2012.08.062

4. Baskin LS, Constantinescu SC, Howard PS, McAninch JW, Ewalt DH, Duckett JW, Snyder HM, Macarak EJ. Biochemical characterization and quantitation of the collagenous components of urethral stricture tissue. J Urol. 1993;150(2 Pt 2):642-7. DOI: 10.1016/s0022-5347(17)35572-6

5. Wood DN, Andrich DE, Greenwell TJ, Mundy AR. Standing the test of time: the long-term results of urethroplasty. World J Urol. 2006;24(3):250-4. DOI: 10.1007/s00345-006-0057-3

6. Altun E. MR Imaging of the Penis and Urethra. Magn Reson Imaging Clin N Am. 2019;27(1):139-150. DOI: 10.1016/j.mric.2018.09.006

7. Frankiewicz M, Markiet K, Krukowski J, Szurowska E, Matuszewski M. MRI in patients with urethral stricture: a systematic review. Diagn Interv Radiol. 2021;27(1):134-146. DOI: 10.5152/dir.2020.19515

8. Patent RF na izobretenie RU 2749869 C2/17.06.2021. Bjul. №17. Veliev E.I., Bogdanov A.B., Katibov M.I., Polyakova A.S. Sposob formirovanija anastomoza na ventral'noj poverhnosti uretry bez peresechenija spongioznogo tela pri strikturah bul'boznogo otdela uretry. (In Russian). Accessed February 19, 2023. URL: https://yandex.ru/patents/doc/RU2749869C2_20210617

9. Bogdanov AB, Veliev EI, Sokolov EA, Metelev AY, Ivkin EE, Tomilov AA, Veliev RA, Marchenko VV, Monakov DM, Katibov MI, Afyouni AS, Furr J, Okhunov Z, Sabanegh E. Nontransecting Anastomotic Urethroplasty Via Ventral Approach Without Full Mobilization of the Corpus Spongiosum Dorsal Semicircumference. Urology. 2021;152:136-141. DOI: 10.1016/j.urology.2020.10.074

10. Osman Y, El-Ghar MA, Mansour O, Refaie H, El-Diasty T. Magnetic resonance urethrography in comparison to retrograde urethrography in diagnosis of male urethral strictures: is it clinically relevant? Eur Urol. 2006;50(3):587-93; discussion 594. DOI: 10.1016/j.eururo.2006.01.015

11. Sung DJ, Kim YH, Cho SB, Oh YW, Lee NJ, Kim JH, Chung KB, Moon du G, Kim JJ. Obliterative urethral stricture: MR urethrography versus conventional retrograde urethrography with voiding cystourethrography. Radiology. 2006;240(3):842-8. DOI: 10.1148/radiol.2403050590

12. Oh MM, Jin MH, Sung DJ, Yoon DK, Kim JJ, Moon du G. Magnetic resonance urethrography to assess obliterative posterior urethral stricture: comparison to conventional retrograde urethrography with voiding cystourethrography. J Urol. 2010;183(2):603-7. DOI: 10.1016/j.juro.2009.10.016

13. Banchik E.L., Mitusov V.V., Dombrovsky V.I., Kogan M.I. Dynamic magnetic resonance imaging in the diagnosis of male urethral diseases (a complex of pulse sequences). Vestnik rentgenologii i radiologii. 2013;(4):33-40. (In Russian). eLIBRARY ID: 20658198; EDN: RKBQQT

14. Dombrowski V.I., Kogan M.I., Banchik E.L., Mitusov V.V. The role of magnetic resonance imaging in the diagnosis of stricture disease of the male urethra. Urologiia. 2015;(2):24-30. (In Russian). eLIBRARY ID: 23608497; EDN: TWQGDD

15. El-Ghar MA, Osman Y, Elbaz E, Refiae H, El-Diasty T. MR urethrogram versus combined retrograde urethrogram and sonourethrography in diagnosis of urethral stricture. Eur J Radiol. 2010;74(3):e193-8. DOI: 10.1016/j.ejrad.2009.06.008

16. Rastogi R, Joon P, Pushkarna A, Agarwal A, Wani AM, Bhagat PK, Gupta Y, Sharma S, Das PK, Parashar S, Sinha P, Chaudhary M, Pratap V. Compar¬ative role of sonourethrography (SUG) and magnetic resonance urethrography (MRU) in anterior male urethral strictures. Ann Clin Lab Res. 2016; 4(4):1-4. DOI: 10.21767/2386-5180.1000140

17. Mikolaj F, Karolina M, Oliwia K, Jakub K, Adam K, Mariusz B, Patrycja N, Marcin M. Retrograde urethrography, sonouretrography and magnetic resonance urethrography in evaluation of male urethral strictures. Should the novel methods become the new standard in radiological diagnosis of urethral stricture disease? Int Urol Nephrol. 2021;53(12):2423-2435. DOI: 10.1007/s11255-021-02994-5

18. Jordan GH, Eltahawy EA, Virasoro R. The technique of vessel sparing excision and primary anastomosis for proximal bulbous urethral reconstruction. J Urol. 2007;177(5):1799-802. DOI: 10.1016/j.juro.2007.01.036

19. Gur U, Jordan GH. Vessel-sparing excision and primary anastomosis (for proximal bulbar urethral strictures). BJU Int. 2008;101(9):1183-95. DOI: 10.1111/j.1464-410X.2008.07619.x

20. Andrich DE, Mundy AR. Non-transecting anastomotic bulbar urethroplasty: a preliminary report. BJU Int. 2012;109(7):1090-4. DOI: 10.1111/j.1464-410X.2011.10508.x