In the management of urethral stricture disease, which investigation provides the most anatomical information about stricture length and location in the posterior urethra, and is the gold standard for planning urethroplasty?

• A Flexible cystoscopy
• B Retrograde urethrogram (RGU) with simultaneous antegrade cystourethrogram (VCUG) ✓
• C Ultrasound urethrogram
• D Magnetic resonance urethrography

Explanation

Combined retrograde urethrogram (RGU) and voiding cystourethrogram (VCUG) — the 'pericatheter' or simultaneous study — is the gold standard for defining stricture length, location, calibre, and the proximal extent in posterior urethral disruptions. It gives complementary information from both ends of the stricture that neither study alone provides. Flexible cystoscopy assesses severity but underestimates length. Ultrasound urethrography (sono-urethrography) is useful but operator-dependent. MRI provides soft-tissue detail but not dynamic imaging.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.