Clinical value of pericatheter urethrography after urethroplasty: Outcomes and technique-specific implications

ABSTRACT Objectives: To evaluate the clinical utility of pericatheter urethrography (PUG) following urethroplasty, compare the safety and outcomes of voiding versus retrograde PUG, and identify factors independently associated with contrast extravasation. Materials and Methods: This retrospective analysis of a prospectively maintained institutional database included patients undergoing urethroplasty between January 2019 and December 2022. Patients were grouped based on whether postoperative PUG was performed and, within the PUG cohort, by imaging technique (voiding or retrograde). Primary outcomes were contrast extravasation and procedure-related complications. Multivariable logistic regression was performed to identify independent predictors of contrast extravasation, adjusting for redo urethroplasty, number of grafts used, and surgical technique. Results: A total of 218 patients were included, of whom 140 (64.2%) underwent PUG. PUG was used more frequently following redo urethroplasty and complex reconstructions requiring multiple grafts or flaps. Among PUG patients (voiding n = 74; retrograde n = 66), contrast extravasation occurred in 13 patients (9.3%) and was significantly higher following retrograde PUG (16.7% vs. 2.7%). Retrograde PUG was associated with higher post-procedure pain and increased rates of febrile urinary tract infection and hematuria. On multivariable analysis, redo urethroplasty and use of more than one graft were independently associated with contrast extravasation, whereas surgical technique was not. At a mean follow-up of 36 ± 14 months, stricture recurrence occurred in 10.1% of patients and was significantly more common in those with contrast extravasation. Conclusion: Contrast extravasation after urethroplasty reflects stricture complexity rather than reconstructive technique. PUG should be used selectively in complex and redo urethroplasty, with voiding PUG preferred when postoperative imaging is indicated.