Comparative Study Of Urethrography And Urethral Ultrasound In Diagnosis Of LS Induced Urethral Stricture

Background and objective Male urethral stricture disease is caused by idiopathic,congenital,infectious,LS,iatrogenic and traumatic injuries and other common causes.Symptomatic urethral stricture is the main complaint and has stenotic characteristics(such as location,length,stenosis Degree),the duration of obstruction and other common urological diseases;the key to the treatment plan and successful operation of urethral stricture disease depends on the accurate diagnosis and detailed assessment of the condition before surgery;commonly used examination schemes include: X-ray urethrography,Ultrasound imaging of urethra;recently CT excretory urethra imaging and MR urethra imaging are also gradually used in preoperative diagnosis and evaluation.At present,reports of cases of anterior urethral stricture caused by sclerosis lichenoids(lichen sclerosus,LS)are gradually increasing,but due to the specificity of the cause of the disease,preoperative imaging data for patients with this type of disease are very important,and domestic There are few related studies;therefore,we explored the imaging characteristics of this disease by retrospectively analyzing the clinical data of 19 patients with LS type anterior urethral stricture.Due to the limitations of the examination conditions,we only collected urethral radiography and urethra The imaging findings of ultrasound imaging are compared with the intraoperative measurement data to provide reference information for the diagnosis of patients with LS urethral stricture disease.Methods The clinical data of 19 patients who were hospitalized in our hospital from September 2017 to November 2019 and were diagnosed with LS urethral stricture were collected and recorded.The patients were 15-73 years old,with an average of 39.58 years old.All patients had a clear history of poor urination before admission and the outpatient urinary flow rate was ?10ml / s.Examination showed obvious LS appearance of glans,foreskin and urethral orifice lesion mucosa pale,hardened texture,tissue atrophy and adhesion;after admission Perform urethrography,urethral ultrasound examination and surgical treatment;the specific process is as follows: 1.Urethral angiography: cis / retrograde X-ray urethra angiography,inject a sufficient amount of iohexol contrast agent through retrograde),The indwelling bladder fistula can be injected with contrast agent through the fistula,measure and record the length of the anterior urethral stricture(distal urethral opening to the proximal end of the stenosis),the diameter of the urethral cavity,check the time required to understand the urethral cavity Whether there are complications,etc.2.Ultrasound examination of the urethra: first check the urethra at rest and then the urethra at the filling stage((1)natural urination of the patient(1)urologist injects sterile saline directly from the outer urethral opening,all of which are adequate Observe the degree of anterior urethral stricture during filling).An experienced sonographer measures and records the stenosis through the ventral side of the penis,the side of the urethra Length,diameter of urethral cavity,time required for inspection,and understanding of complications in the urethral cavity and scars around the lesion;3.Intraoperative measurement: accurate measurement and recording of the stenosis when the urethra is natural and the penis is completely unaffected The length of the urethra and explore the urethral cavity for complications.Collect the data obtained by the above two conventional inspection methods for comparison,including inspection cost,inspection time,etc.,as well as the length of stenosis,urethral cavity diameter,and whether there are complications,etc.,and compare it with the data of the actual measurement of stenosis length To evaluate the advantages and disadvantages of urethral radiography and urethral ultrasound in the diagnosis of LS type urethral stricture.SPSS 22.0 was used for statistical analysis.Results Of the 19 patients included,the cost of routine examination was: 1 basis for radiography and 0.8 basis for ultrasound examination;the time required for routine examination:(23.53±3.596)min for radiography and(16,26±2.864)min for ultrasound examination;routine examination of urethral stenosis length: X-ray urethrography is(39.21±14.01)mm,ultrasound urethra examination is(37.80±12.82)mm,and the length of the urethral tract in the stenosis is(38.35±12.97)mm.Accompanying complications:(1)X-ray angiography: 4 cases of urethral diverticulum,1 case of urethral calculi,2 cases of bladder stones,0 cases of urethral skin fistula,0 cases of pseudourethra,1 urethral atresia(2)Urethral ultrasound examination: 4 cases of urethral diverticulum,2 cases of urethral stones,2 cases of bladder stones,1 case of urethral skin fistula,0 cases of pseudourethra,and 1 urethral atresia.(3)Intraoperative exploration: 4 cases of urethral diverticulum,3 cases of urethral stones,2 cases of bladder stones,2 cases of urethral skin fistula,1 case of pseudourethra,and 1 urethral atresia.Conclusion 1.The common points of X-ray urethrography and urethral ultrasound examination of LS anterior urethral stricture: low inspection cost,convenient and fast inspection process,and short inspection time. Both the length of the narrow urethra and the narrowest urethra can be measured The diameter of the cavity,but the measurement results are all deviations,and the accompanying complications can be found.2.The difference between X-ray urethrography and urethral ultrasound examination of LS-type anterior urethral stricture: X-ray contrast imaging is slightly more expensive,longer,and easier to operate than ultrasound examination,and the length deviation of the narrow section is slightly larger and the narrowest part The diameter of the urethral cavity is low and the complication is incomplete;in addition,the ultrasound examination has good repeatability and no radioactive exposure,and the patient can tolerate and comply with it well.Phenomena,etc.3.For complex LS-type anterior urethral strictures,we can obtain more comprehensive lesion information by combining two inspection methods,which can help guide surgical decision-making for treatment of urethral strictures,and can provide good evaluation of clinical efficacy before and after treatment Basis.