Added Clinical Benefit of Voiding Cystourethrography Combined With Standard-of-Care Retrograde Urethrography for Adult Male Urethral Strictures and Urethral Injuries: A Pictorial Review

Precise imaging constitutes the cornerstone of effective urethral stricture and injury management. Although retrograde urethrography (RUG) is widely used as the investigation of choice to assess the anterior urethra, it comes with several limitations. In some cases, voiding cystourethrography (VCUG) can provide complementary anatomical and functional information that can be highly influential on clinical decision-making. More specifically, VCUG allows accurate visualization of the urethra proximal to the stricture, as well as a more reliable assessment of the stricture’s length in virtually obliterative strictures and stenoses, and gaps in case of pelvic fracture injury. Also, it can introduce unique data, such as bladder neck integrity, prostatic urethra patency, and dynamic voiding patterns. This information can often impact the therapeutic plan, including the choice between endoscopic and open approach, timing of repair, and continence prognosis. In this pictorial review, by providing examples from our clinical practice and describing our technique, we aim to illustrate the imaging spectrum of urethral strictures and injuries on VCUG, highlighting its additional diagnostic input and discussing common interpretive pitfalls.