Independently Interpreted Retrograde Urethrography Does Not Accurately Diagnose and Stage Anterior Urethral Stricture: The Importance of Urologist-performed Urethrography

ObjectiveTo compare the accuracy of retrograde urethrogram (RUG) interpretation between the primary physician performing the procedure and the independent physician interpreting the films to evaluate the suitability of relying on independent physician interpretations for the purposes of preoperative urethral stricture surgery planning.MethodsA retrospective review was performed on a cohort of 397 patients undergoing anterior urethroplasty over a 7-year period at a single center. Preoperative RUG findings as reported at the time by both the urologist performing the urethrography and the independent interpreter (radiologist) were abstracted and compared with stricture location and length as measured intraoperatively. RUG adequacy was defined as a comment on the presence, location, and length of the urethral stricture.ResultsOnly 49% of independently reported RUG studies were deemed adequate, and 87% of independently reported studies correctly diagnosed the presence of a stricture. Forty-nine percent of independently reported studies correctly identified stricture location compared with 96% of primary physician–reported cases (P <.001). The reported stricture lengths were 3.23 ± 2.25, 4.19 ± 2.49, and 4.51 ± 2.65 cm for the independently reported RUGs, primary physician–reported RUGs, and the intraoperative measurements, respectively. Differences between all the groups were statistically significant (P <.001). Independently reported length had a 0.47 R2 coefficient of correlation to the intraoperative length (P <.001) compared with a 0.93 R2 coefficient of correlation between primary physician–reported length and intraoperative length (P <.001).ConclusionIndependently reported RUGs are not as accurate as primary physician–reported RUGs, and caution should be used when they are used for preoperative planning.