Colour Doppler ultrasonographic location of the bulbourethral artery, and its impact on surgical outcome.

Objective: To assess the location of bulbourethral arteries in men with a 'normal' urethra and to study anatomical alterations in men with urethral stricture.

Patients And Methods: A linear-array transducer was used on the ventral surface of the penis to study the urethra. Fifteen men with a normal urethra and 15 with a stricture of the bulbar urethra were assessed. After conventional grey-scale imaging to evaluate the extent of disease, the urethral artery in the bulbar urethra was located by colour Doppler ultrasonography.

Results: The site of the urethral arteries in 'normal' men varied among individuals; they were at the 10-2 o'clock position in six men, 8-10 o'clock and 2-4 o'clock in six, and at the 4-8 o'clock position in three. In normal men the symmetry of arteries was maintained and the mean distance from the lumen was 2.67 mm. In men with urethral stricture, there was a loss of symmetry in all cases. In a dense stricture the urethral arteries could not be detected on either side in three of cases, while only a single artery was seen in three. In two men, both the arteries were on one side. The mean distance of the urethral artery from the lumen of urethra was 1.88 mm.

Conclusions: Contrary to the popular belief that the urethral arteries are located at the 3 and 9 o'clock position, we found that there was no predictable pattern for their anatomy. These observations might have implications for treating urethral stricture disease with visual internal urethrotomy, as they could help to avoid injury to the bulbourethral artery.