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Descending urethral ultrasound of the native and reconstructed urethra in patients with hypospadias

Departments of ¹ Radiology and ² Urology, University of Cambridge and Addenbrooke's Hospital NHS Trust, Hills Road, Cambridge CB2 2QQ, UK

View larger version (57K): [in a new window]   Figure 1. Sagittal urethrosonographic frame capture montage in a patient who has undergone reconstructive surgery for hypospadias. There is mucosal irregularity of the neo-distal urethra (arrow), which did not impede the flow of urine. The corpus spongiosum (S) surrounding the urethra (asterisk) can be seen separate from, and slightly echogenic compared with, the corpus cavernosum (C).

View larger version (72K): [in a new window]   Figure 2. (a) A tight stricture is demonstrated in the neo-distal urethra on this sagittal montage (arrow). The prostatic urethra (P) is demonstrated proximal to the bulbar urethra (asterisk) in this example. (b) This was confirmed with ascending contrast urethrography (arrow). This oblique radiograph results in some foreshortening of the urethra accounting for the difference compared with the true sagittal ultrasound montage. The tip of the catheter is demonstrated in the very distal neo-urethra (black arrow) and there is free spillage of contrast medium because an adequate seal cannot be obtained with this technique (arrowhead).

View larger version (53K): [in a new window]   Figure 3. Montage of sagittal frame capture images from the descending urethrosonographic video of a patient with uncorrected hypospadias. The more proximal images are obtained with the penis "pinched", the urethra (asterisk) distended and insonated from the ventral surface. The distal image of the tip of the penis is obtained during micturition insonated from the dorsal surface. The ventral urethral meatus is clearly demonstrated (arrow) with a more proximal irregular narrowing (arrowheads), which did not impede the flow of urine. The thin echogenic line (curved arrow) bordering the anechoic column of urine represents the urethral mucosa.

View larger version (139K): [in a new window]   Figure 4. Static sagittal B mode images montaged to demonstrate the persistent urethral web (arrow) at the level of the membranous urethra at the proximal margin of the bulbar urethra (asterisk).