How we diagnose urethral strictures

Diagnosing urethral strictures usually involves a combination of radiographic imaging and cystoscopy. The tests we use to make a diagnosis include:

  • Retrograde urethrogram: This is the most important test used to diagnose urethral strictures. It involves placing a small amount of contrast dye into the urethra in order to outline the entire area. This allows the surgeon to identify the location and length of the stricture.
  • Cystoscopy:  A cystoscopy involves placing a small camera into the urethra and bladder. This procedure can be helpful in detecting strictures. Rarely, if the entire length of stricture can be seen through the scope or if the stricture is at the bladder neck, a retrograde urethrogram is not needed.
  • Voiding cystourethrogram: For this test, the bladder is filled with contrast dye and captures images of the full bladder and urethra while the patient urinates. This is a very important diagnostic test for pelvic fracture urethral injuries and any instance of the urethra being entirely obstructed.
  • Flow rate and residual urine assessment: For this test, a patient urinates into a funnel for doctors to measure the strength of the urine stream. Following the test, the residual urine left in the bladder is also measured.  
  • Urine culture: Urine cultures are collected prior to any surgery to ensure there is no active infection and to help guide antibiotics prior to the operation.