Pediatric cystoscopy of male urethral strictures: an accurate and useful preoperative surgical decision making tool

Gregory P. Murphy, Kushan D. Radadia, Jonathan Weese, Cooper R. Benson, Niraj Badhiwala, Alethea Paradis, Joel Vetter, Steven B. Brandes

Research output: Contribution to journalArticle

Abstract

INTRODUCTION: To evaluate flexible pediatric cystoscopy (FPC) as an adjunctive procedure to retrograde urethrography (RUG) and voiding cystourethrography (VCUG) in the preoperative setting for male urethral strictures. Since imaging interpretation of stricture length and caliber can be difficult at times, we sought to evaluate diagnostic utility of FPC to predict reconstructive surgery. MATERIALS AND METHODS: Reconstructive urology databases at Washington University and Columbia University were queried from 2010-2017. A total of 185 anterior urethroplasty patients met inclusion criteria. All surgeries were performed by a single surgeon. There were 102 patients that underwent preoperative FPC (7.5 Fr in diameter). Surgical urethroplasty techniques employed were: ventral or dorsal onlay buccal mucosa graft, fasciocutaneous penile skin flap, excision and primary anastomosis or augmented anastomotic. We analyzed the RUG, VCUG, FPC, and intraoperative details of the urethral strictures by univariate and multivariate statistics. RESULTS: Mean patient age was 47.2 (+/-16.5) years. Of the patients who underwent FPC, 42.2% were narrower than the FPC, and 57.8% were wider. Intraoperative stricture length better correlated with FPC findings compared to RUG/ VCUG (r = 0.834 versus r = 0.766) (p < 0.001). Moreover, inability to pass the FPC through the stricture correlated with the need to perform urethral stricture excision or complete reconstruction of the urethral plate (p = 0.005), rather than onlay urethroplasty. CONCLUSION: Preoperative FPC is a useful adjunctive tool in the evaluation of urethral strictures. FPC facilitates stricture assessment by accurately correlating with intraoperative stricture length and predicting the need to excise or graft during reconstruction.

Original languageEnglish
Pages (from-to)10228-10232
Number of pages5
JournalThe Canadian journal of urology
Volume27
Issue number3
StatePublished - Jun 1 2020

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    Murphy, G. P., Radadia, K. D., Weese, J., Benson, C. R., Badhiwala, N., Paradis, A., Vetter, J., & Brandes, S. B. (2020). Pediatric cystoscopy of male urethral strictures: an accurate and useful preoperative surgical decision making tool. The Canadian journal of urology, 27(3), 10228-10232.