Diagnosis and evaluation of anterior and posterior urethral stenosis in men: Clinical and radiological aspects

Background: The diagnosis of urethral strictures logically includes a precise assessment of urinary symptoms, but must also take into account the impact on sexuality. What role will new imaging play in 2024?

Methods: A literature review from December 2020 to December 2023 was carried out, combined with a synthesis of the recommendations of the American, Canadian, European and French urology associations. References from these recommendations were also used.

Results: The evaluation of urethral stenosis comprises several phases. First phase: questioning will focus on making an etiological diagnosis and establishing the impact on urinary and sexual quality of life, with the help of questionnaires. Second phase: the clinical examination should not be overlooked, as it will have a major impact on treatment proposals. Third phase: additional examinations are needed to make a positive diagnosis of the stenosis, and to assess its extent, severity and consequences. These include flowmetry/post-voiding residual (PVR), retrograde uretrography (RUG) and voiding cystourethrography (VCUG) together with fibroscopy. Today, there is a growing consensus in favor of MRI for the evaluation of posterior urethral stenosis, in particular to search for associated lesions.

Conclusion: The evaluation of urethral strictures should focus on making a positive and etiological diagnosis. It is essential to assess the impact on voiding and sexual activity, as well as any associated lesions, which may affect management and the information given to patients.