EVALUATION
At the Center for Reconstructive Urology, the evaluation of a patient with urethral stricture disease begins with a complete physical examination. We also perform urethroscopy and urethral imaging, studies that show the exact location and length of the urethral stricture. This information is essential to developing a successful treatment plan.
Urethroscopy and Urethral Imaging
In urethroscopy, a small, flexible, lubricated telescope is gently placed into the urethra to look at the stricture. This study lets the doctor view the urethra between the tip of the penis and the beginning of the stricture.
The standard urethral imaging procedures are retrograde urethrogram (RUG) and voiding cystourethrogram (VCUG). These studies let the doctor see the entire urethra. They combine an imaging technique with the use of a contrast medium introduced into the urethra with a specialized adapter that gently forms a seal at the tip of the penis. No needles or catheters are required.
The contrast medium is a clear fluid that appears white on an X-ray. As long as the stricture does not completely close the urethra, the contrast medium passes through, outlining the area of narrowing and the normal area around it. Films are taken during introduction of the medium and while it is voided from the urethra.
After an Injury
Patients who suffer urethral injuries after a pelvic fracture generally suffer a disruption of their urethras, a condition where the urethra is cut completely, and the ends separate (generally 1cm to 4cm). These patients are completely unable to urinate, and they often have suprapubic tubes placed on an emergency basis after the injury. A suprapubic tube is a catheter that enters the bladder directly through the lower abdomen, so urine that enters the bladder can drain into a collection bag.
In these evaluations, the doctor images the urethra from above (through the suprapubic tube) and below (from the tip of the penis). Contrast introduced from above fills the bladder and the urethra down to the point where the urethra is injured. Contrast introduced from below fills the urethra up to the other end of the injury. The doctor measures the gap between the two ends and determines the exact length and location of the damage.
Evaluating Vascular Damage
Patients who suffer traumatic urethral injuries often have vascular (blood supply) and nerve damage involving the penis, too, and over half suffer erectile dysfunction because of the injury. We evaluate vascular and erectile function before urethral reconstruction. We establish whether the blood supply to the urethra will support a successful repair, and we also gain information for planning treatment of erectile dysfunction after urethral reconstruction.
One of two studies is recommended, depending on the patient's history: a sleep study of erectile function or a duplex ultrasound of the penis.
In a sleep study, nocturnal erectile function is measured in a sleep laboratory. Men normally have several erections during rapid-eye-movement (REM) sleep. Normal nocturnal erections indicate that there is no vascular injury to the penis or urethra. Impaired or absent nocturnal erections indicate vascular and/or neurological impairment and the need for further evaluation.
Duplex ultrasound of the penis measures the blood supply of the penis more directly, particularly the arteries that provide blood flow to the urethra.
How We Schedule Tests
At our Center, we prefer to perform the recommended studies at the same time as the initial consultation. This gives us a full picture more promptly, so we can make a definitive diagnosis and make the right treatment recommendations.
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