Contrast enhanced Ultrasound (CEUS) with Shear Wave elastography (SWE) allows excellent delineation of length of urethral strictures along with estimation of surrounding spongiofibrosis without exposure to ionising radiation. The aim of our study was to evaluate the role of CEUS and SWE for evaluation of anterior urethral strictures

34 patients diagnosed to have anterior urethral stricture on RGU were prospectively evaluated with CEUS and SWE. Based on intraoperative findings and clinical follow up, diagnostic performance of CEUS and RGU was evaluated; and correlation obtained between elastographic patterns (qualitative) and strain ratio (quantitative) obtained on SWE and the response to treatment.

Out of 34 patients, stricture location was proximal bulbar in 16, mid bulbar in 9, distal bulbar in 7 and proximal penile in 2 patients. 26 patients underwent OIU with cold knife, 2 underwent endodilatation, 2 underwent end to end (E-E)urethroplasty and 4 underwent BMG urethroplasty. CEUS/SWE changed the surgical approach from E-E urethroplasty to BMG urethroplasty because of the underestimation of length with RGU. The mean stricture length on RGU, CEUS and intraoperatively was 1.7 ± 1.1, 2.2 ± 0.9 and 2.3 ± 0.8 cm respectively. On SWE, the elastographic strain pattern was red (high strain) in 28 patients and green (equal strain) in 6 patients and median (range) strain ratio was 12.8 (4.6- 17.4). There were no intraoperative/postoperative complications. At 6 months, among 26 patients who underwent OIU, the mean maximum flow rate in patients with green and red patten on SWE was 13.3 ± 2.8 and 11.5 ± 1.7 ml/sec respectively, although none of them required any further intervention.

CEUS helps in more accurate delineation of stricture length as compared to RGU in patients with anterior urethral stricture without exposure to ionizing radiation. Additionally, strain patterns on SWE correlate with maximum flow rate at 6 months post OIU and may serve as predictor of treatment failure. The combination of CEUS with SWE, thus, in future, could play a key role in operative decision making.