title: 'Real-time sonoelastography' in anterior urethral strictures: A novel technique for assessment ofspongiofibrosis.
abstract: BACKGROUND
  Spongiofibrosis assessment is critically important in the evaluation of anterior urethral strictures as its severity is directly proportional to stricture recurrence and thus affects management. Retrograde urethrography (RGU) is ineffective in the evaluation of spongiofibrosis. Sonourethrography (SUG) delineates it but does not accurately estimate its depth. Real-time elastography (RTE), a newer technique that not only attempts a qualitative but also quantitative estimation of spongiofibrosis (tissue stiffness) which results due to underlying pathological processes.
  
  
  METHODS
  In the present study, various elastographic patterns and strain ratios in anterior urethral stricture patients were studied and compared to operative and histopathological findings. Sixty-three RGU diagnosed anterior urethral stricture cases were taken and re-evaluated by SUG and SE by another radiologist who was blinded to the findings of the RGU. Strain patterns and ratios of spongiofibrotic segments were documented and compared with operative findings as gold standard.
  
  
  RESULTS
  Blue pattern on RTE showed 100% concordance with severe fibrosis as evaluated against histopathological findings whereas green pattern showed 87.5% concordance with moderate degree of fibrosis. Severe degree of fibrosis cases, confirmed on histopathology had a significantly higher mean strain ratio (10.51 ±2.297) as compared to moderate degree (6.33 ±2.353) (p <0.001 S).
  
  
  CONCLUSIONS
  Real time sonoelastography in the evaluation of spongiofibrosis not only assesses it qualitatively but also quantifies it. Strain ratios are statistically better indicators for estimating spongiofibrosis.
authors.affiliation: Department of Urology, SMS Medical College and Hospital, Jaipur, India.
authors.forename: Shyam Manoharlal
authors.initials: SM
authors.lastname: Talreja
authors.affiliation: Department of Urology, SMS Medical College and Hospital, Jaipur, India.
authors.forename: Sher Singh
authors.initials: SS
authors.lastname: Yadav
authors.affiliation: Department of Urology, SMS Medical College and Hospital, Jaipur, India.
authors.forename: Vinay
authors.initials: V
authors.lastname: Tomar
authors.affiliation: Department of Urology, SMS Medical College and Hospital, Jaipur, India.
authors.forename: Neeraj
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Urology, SMS Medical College and Hospital, Jaipur, India.
authors.forename: Usha
authors.initials: U
authors.lastname: Jaipal
authors.affiliation: Department of Urology, SMS Medical College and Hospital, Jaipur, India.
authors.forename: Shivam
authors.initials: S
authors.lastname: Priyadarshi
keywords: anterior urethral strictures; elastography; retrograde urethrography strain pattern strain ratio