Objective To investigate the application value of multi-slice spiral CT (MSCT) urethra imaging in the diagnosis and treatment of urethral stricture. Methods 65 patients with anterior urethral stricture who were diagnosed in the hospital from January 2015 to June 2018 were enrolled. Of them, 30 underwent MSCT urethrography (MSCT group), and 35 underwent traditional X-ray urethrography (X-ray group). Both groups underwent internal urethrotomy with cold knife. The diagnosis and treatment of the two groups was compared. Results There was no significant difference in the detected results of urethral stricture length in the two groups before and during surgery (P>0.05). There was no significant difference in the operation time, postoperative hospital stay, postoperative Qmax or incidence of complication between the two groups (P>0.05). However, the proportion of transferring to open surgery in the MSCT group was significantly lower than that in the X-ray group (P<0.05). The urethral stricture or display for atresia anatomy structure were better than those in than the X-ray group. Conclusion MSCT urethra imaging can clearly show the urethral anatomy structure, which is of great value in the diagnosis of urethral stricture and surgical guidance.