The Role of Magnetic Resonance Imaging in Preoperative Evaluation of Anterior Obliterative Urethral Strictures

Background/Objectives: Conventional imaging modalities are often inadequate for evaluating the proximal extent of anterior obliterative urethral strictures. Magnetic Resonance Imaging (MRI), with its superior soft tissue resolution, provides detailed anatomical insights and significantly contributes to surgical planning in such cases. Methods: Four male patients aged 26-63 years with anterior obliterative urethral strictures were evaluated using MRI in addition to conventional imaging. All MRI scans were performed following a modified Joshi protocol. Clinical data, MRI findings, and surgical outcomes were retrospectively reviewed. Results: MRI successfully delineated stricture length, location, periurethral fibrosis, and proximal urethral status in all cases, correlating well with intraoperative findings. Case 1 showed a 2 cm proximal bulbar obliteration, excised with end-to-end anastomosis. Case 2 had a 2.5 cm distal bulbar stricture, managed similarly. Case 3 revealed multi-segmental strictures, treated with a combination of anastomosis, graft, and Kulkarni urethroplasty. Case 4 demonstrated a rare 9 cm distal penile obliteration with preserved proximal urethra, treated with anastomotic repair. MRI provided critical anatomical detail for surgical decision-making. Conclusions: MRI is a valuable imaging modality for the evaluation of anterior obliterative urethral strictures, particularly when the proximal extent of the stricture cannot be visualized with conventional imaging techniques. In our case series, MRI enabled precise delineation of the stricture length and surrounding anatomical structures, which was critical for selecting the most appropriate surgical approach.