Impact of urethral ultrasonography on decision-making in anterior urethroplasty

OBJECTIVE To assess the impact of urethral ultrasonography on decision-making in complex anterior urethral reconstructions. PATIENTS AND METHODS This was an institutional review board approved retrospective review of 500 patients receiving anterior urethroplasty from 1985 to 2007. In all, 232 patients met the inclusion criteria of documented preoperative clinical assessment, retrograde urethrogram (RUG), urethral ultrasonogram, and measured operative stricture length and dimensions. At the time of surgery, intraoperative urethral ultrasonography was performed. A preoperative planned reconstructive approach was compared with the reconstructive procedure performed to determine how often urethral ultrasonography impacted operative decision-making. RESULTS Of the 232 patients in our review, 115 (50%), 88 (38%) and 16 (7%) received respectively anastomotic, buccal mucosa graft and fasciocutaneous flap urethroplasties. Intraoperative ultrasonography changed surgical approach in 44 patients (19%), and was integral in deciding between two equally possible approaches in an additional 61 patients (26%). In patients whose approach was changed from anastomotic urethroplasty to an onlay urethroplasty, mean RUG length was 2.0 cm while mean ultrasound length was significantly longer at 3.4 cm (P = 0.02). When the surgical approach was changed from an onlay urethroplasty to an anastomotic urethroplasty, mean RUG length was 2.7 cm compared with a significantly shorter intraoperative ultrasonography length of 1.9 cm (P < 0.005). CONCLUSIONS Ultrasonography of the anterior urethra directly influenced our reconstructive operative approach in 45% of patients. It is a simple, reliable procedure that adds valuable clinical insight and objective radiographic data to help select the optimal anterior urethral reconstructive approach.