Urethral stricture is increasing in prevalence, mainly due to the increase in the number of transurethral procedures. The gold standard for the diagnosis of strictures in the anterior urethra is retrograde cystourethrography (RCU), however, it has some counterpoints, such as the lack of accuracy in assessing the length of the stenosis, lack of evaluation of spongiofibrosis and the use of ionizing radiation and contrast. Urethral ultrasound (UUS) is a relatively simple method to assess the length of stricture, in addition to demonstrating an improved correlation with periurethral anatomy and the presence of spongiofibrosis. This study aims to evaluate the role of UUS in the assessment of male urethral stenosis and in optimizing the therapeutic decision.

A comparative study was performed in 12 patients with anterior urethral stenosis, using UUS (12 MHz transducer) as a complement to RCU in the evaluation, to determine if there was a greater accuracy in length scouting of the stenosis, presence of spongiofibrosis and change in surgical approach.

The mean age of the patients was 60.7 years, with 58.33% of the stenosis located in the bulbar and 41.67% in the penile urethra. The evaluation with UUS brought additional categories of information. Spongiofibrosis was found in 66.67% of the cases, with a positive correlation with a change of surgical approach, an alteration that cannot be found in the RCU. The length of the stenosis at UUS showed a greater correlation with intraoperative findings than the values ​​found at RCU, with significance. The change in therapeutic modality occurred in 58.33% of patients after UUs, due to the increased size of the stenosis and the presence of spongiofibrosis.

RCU is the most used technique in diagnosis, but UUS has been shown to be an additional tool in the study of the urethra, with better assessment of the length and location of the stenosis, in addition to the assessment of periurethral tissues.
While larger strictures are best treated with reconstructive techniques, small strictures can be treated endoscopically. Considering that, a correct assessment of the length of the stenosis is essential for a more accurate treatment. In addition, RCU does not provide a correct assessment of the extent of spongiofibrosis, which can directly impact the correct choice of surgical technique.
The use of UUS provides a real benefit in the evaluation of these characteristics.

This study demonstrated the advantage of the association of UUS in the evaluation of cases of anterior urethral stenosis. Real-time ultrasound scanning highlights aspects that are not seen in the RCU, with superiority in identifying spongiofibrosis and stenosis length, leading to changes in conduct and better treatment results.