Voiding Urosonography: Normal and Abnormal Appearance of the
Urethra
Carmina Duran Feliubadaló, Luis Riera Soler, Cesar Martin Martinez, Francesc Novell Teixido
UDIAT-CD, Sabadell (Spain)
Purpose: Voiding urosonography (VUS) enables high quality morphologic studies of both the
upper urinary tract and male urethra. The main purpose of this work is to demonstrate the
diagnostic capacity of VUS for congenital anomalies of the urethra or related conditions.
Materials and methods: Between October 2005 and May 2009, we performed VUS in 261 boys
(age range 2 days-16 years). We used a 6–4 MHz convex transducer to study the entire urinary
tract including the urethra through a transperineal and/or transpelvic approach. To perform
VUS, we used a specific harmonic imaging mode based on pulse inversion with a predetermined
low (0.16–0.22) mechanical index and administered a galactose-based contrast agent. During
voiding, we focused on whether there was adequate distention and homogeneous caliber of the
whole urethra, as well as continuous progression of the contrast material. If any deviation from
the normal appearance of the urethra was observed at VUS, voiding cystourethrography (VCUG)
was performed to confirm the findings.
Results: Pathological urethral findings in newborns: 5 patients studied for oligohydramnios and
prenatal hydronephrosis were diagnosed with posterior urethral valves; 2 patients with scrotal
hypospadias were diagnosed with diverticulum of the prostatic utricle (one in the context of
WARG syndrome). Pathological urethral findings in boys: two 7 and 16-year-old boys with
difficulty in urinating and recurrent infections were respectively diagnosed with anterior
urethral valves and congenital stricture of the bulbar urethra. In all these cases, the findings at
VUS and VCUG showed good correlation. Variants of normality were also identified with VUS: a
small prostatic utricle and one Cobb's Collar. Moreover, 3 ureteroceles were identified with VUS,
making it possible to rule out ureterocele prolapse which could cause bladder outlet
obstruction.
Conclusion: VUS not only enables the correct morphological study of the male urethra, but it also
enables the specific diagnosis of congenital urethral anomalies. In conclusion, VUS is as accurate
as VCUG and spares the patient's pelvis and gonads from radiation.