Clinical usefulness of transcutaneous and transrectal retrograde sonourethrography

Abstract

Purpose: The aim of this study was to determine if transcutaneous and transrectal ultrasonography of the male urethra with retrograde jelly injection into the urethra (sonourethrography) was clinically useful. Subjects and Methods: Sonourethrography was performed in cases in which indwelling urethral catheter insertion was difficult, cases with urethral stricture, and a case with urethral injury. Cases with urethral stricture were placed in the lithotomy position. Cases in which indwelling urethral catheter insertion was difficult and the case with urethral injury were placed in the supine position. In the cases with urethral stricture, transcutaneous and transrectal sonourethrography was performed and the urethra was observed from the anterior urethra to the bladder neck. The location, number, and length of urethral strictures were evaluated. In the cases in which indwelling urethral catheter insertion was difficult and the case with urethral injury, only transrectal sonourethrography was performed. The reason for the difficulty of indwelling urethral catheter insertion and the continuous urethral lumen after injury were evaluated. Sonourethrography-guided urethral catheter insertion was also performed. Results and Discussion: Five cases in which indwelling urethral catheter insertion was difficult, four cases of urethral stricture, and one case of urethral injury were enrolled. Two cases of false tracts, two cases of benign prostate hyperplasia, and one case of normal urethra made up the cases in which indwelling urethral catheter insertion was difficult. In all five cases, the reason for the difficulty of indwelling catheter insertion were identified, and sonourethrography-guided indwelling urethral catheter insertion was effective and safe. Of the four cases of urethral stricture, three cases were bulbar urethral strictures and one case was anastomotic urethral stricture after radical prostatectomy. In all cases, the strictures were clearly observed using sonourethrography. The anastomotic urethral stricture after radical prostatectomy was clearly observed using transrectal sonourethrography. In all of the cases of urethral stricture, the stricture findings were the same as the intraoperative urethroscopic findings. In the case of urethral injury, continuous urethral lumen, hematoma around the urethra, and false tract were observed. Severe adverse events were not seen in any cases. Conclusion: Anatomical evaluation of the male urethra from the anterior urethra to the bladder neck can be precisely done using transcutaneous and transrectal sonourethrography. In addition, sonourethrography can be used to reliably and safely assist indwelling urethral catheter insertion.