NEAUA - Retrograde Urethrogram Findings and Urethral Stricture Recurrence

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Retrograde Urethrogram Findings and Urethral Stricture Recurrence
Madeline Cancian, MD, Atip Chatsudthipong, MD, Kennon Miller, MD.
Brown University, Providence, RI, USA.

BACKGROUND: Retrograde urethrograms (RUG) have been utilized 2-3 weeks after urethroplasty to help guide management of indwelling urethral catheters. To our knowledge, there is no published data to guide RUG interpretation. Our goal was to classify post-operative RUG findings and determine if they predicted restricturing of the urethra.
METHODS: All available post-urethroplasty RUGs between 4/1/2005 to 6/1/2016 were reviewed by one author (KSM). Results were classified into four categories: normal, contour irregularity, contained extravasation and frank extravasation (figure 1). Stricture recurrence was defined as symptoms with inability to pass a 16 French flexible cystoscope or evidence of stricture on subsequent RUG. Basic diagnostics were examined looking at sensitivity, specificity and association using SAS.RESULTS: 105 patients were included (table 1). Median follow up from time of post-operative RUG to last known follow up was 35 months [range 6-130 months]. Findings of contour irregularity or contained extravasation on RUG were not associated with an increased risk of subsequent stricture. Frank extravasation had 50% positive predictive value (PPV) for subsequently developing a recurrent stricture at location of surgery. The sensitivity was 27% and specificity was 93%, with an increased odds ratio of 7 for developing a subsequent restricture.
CONCLUSIONS: Frank extravasation on post-operative RUG had a high specificity for predicting recurrence of urethral stricture and a PPV of 50%. In these patients, it has been our practice to replace the catheter until RUG findings resolve. The catheter was not replaced for intermediate RUG findings of contour irregularity and contained extravasation. As these data show intermediate RUG findings were not predictive of recurrent stricture, there is no indication that prolonged catheterization in this population could improve restricture rates.

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