Q: Why is the position of the penis critical when performing a retrograde urethrogram / ascending urethrogram for possible urethral stricture? show answer
Urethral stricture (post radiation)
Patient with known urethral stricture post radical prostatectomy for prostate adenocarcinoma and radiation therapy to the pelvis for recurrence. Gradually decreasing urine stream. Hesitancy, dysuria, and nocturia. Re-evaluate stricture.
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Scout image: Multiple clips from a radical prostatectomy.
Retrograde urethrogram (RUG):
There is a 1.4 cm narrowing in the bulbar urethra (to approximately 4 mm), which did not relax on subsequent views. No leak. When turned to the left oblique position, the penis could not be straightened out fully and the length of the stricture is foreshortened.
The penile urethra is normal.
Voiding cystourethrogram (VCUG):
The posterior urethra is normal. No leak or stricture. The vesicourethral junction and anastomosis funnels normally during voiding. No post void residual. The bulbar urethra stricture can be seen, but is not as well evaluated as on the retrograde/ascending urethrogram.