Urethral stricture - post radiation

Case contributed by Dr Matt A. Morgan

Presentation

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.

Patient Data

Age: 65 years
Gender: Male
Fluoroscopy

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.

Case Discussion

Technique is important for retrograde evaluation of urethral strictures. It is of critical importance to keep the urethra as elongated as possible to avoid foreshortening a stricture and making it appear shorter than it really is.

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