The Importance of Cystoscopy in Diagnosis and Treatment of Urethral Stricture Following Transurethral Prostatectomy.

BACKGROUND: Transurethral prostatectomy is the gold standard surgical treatment of bladder outlet obstruction due to benign enlargement of the prostate, with more than 30,000 procedures performed annually in the United States alone. The success rate of this minimally invasive procedure is high and the results are durable. The development of urethral stricture is a long-term complication of the procedure and is noted in about 2% of patients. The stricture narrows the urethral lumen, leading to re-appearance of obstructive urinary symptoms. Traditionally, the evaluation of the stricture was performed by retrograde urethrography. Advancements in the fields of flexible endoscopy allowed rapid inspection of the urethra and immediate dilatation of the stricture in selected cases. OBJECTIVES: To compare the efficacy of urethrography versus cystoscopy in the evaluation of urethral strictures following transurethral prostatectomy. METHODS: A retrospective review was conducted of a series of 32 consecutive patients treated due to post-transurethral resection of prostate (TURP) urethral stricture. RESULTS: Twenty patients underwent both tests. In 16 there was concordance between the two tests. Four patients had no pathological findings in urethrography but had strictures in cystoscopy. All strictures were short (up to 10 mm) and were easily treated during cystoscopy, with no complaints or re-surgery needed in 24 months follow-up. CONCLUSIONS: Cystoscopy was superior to urethrography in the evaluation of post-TURP strictures. Strictures where often short and treated during the same procedure. We recommend that cystoscopy be the procedure of choice in evaluating obstructive urinary symptoms after TURP, and retrograde urethrography be preserved for selected cases.

Running water sound technique in contrast-based voiding cystourethrogram: A case-control study.

BACKGROUND: An intervention that can reduce the patient void time during a voiding cystourethrogram (VCUG) procedure can reduce the total radiation dose to the patient. This is because a delay in voiding leads to a high number of intermittent screenings to monitor if voiding occurs. This study assessed the impact of running-water sound (RWS) upon patients' voiding parameters and fluoroscopy screening times during VCUG examinations among children and adults. MATERIALS AND METHODS: A case-control study involving 252 patients was undertaken which consisted two groups (control and test) of adults and children. The test groups underwent VCUG with RWS technique while the control groups underwent the procedure normally. T-test was used to compare the study parameters between the two groups and a p-value less than 0.05 was interpreted as significant. RESULTS: The mean screening times (s) for children who underwent VCUG with and without RWS were 17.15 ± 2.5s and 30.61 ± 5.1s respectively (p = 0.0024). For adults, the RWS technique recorded a mean screening time of 37.36 ± 4.4s while the non-RWS procedures recorded 49.80 ± 5.2s (p = 0.001). The participants who received RWS intervention also felt the urge to void earlier than those who received no RWS intervention. The differences were also statistically significant for both children and adults. CONCLUSION: The study being one of the first in this subject area indicates that the application of RWS technique induces early urge of iodinated-contrast voiding, and reduces voiding and fluoroscopy screening times during VCUG among children and adults. This simple technique can potentially enhance current practice.

Ureterocolic fistula diagnosed on the basis of diuretic renogram and direct radionuclide cystography.

Ureterocolic fistulae are a rare phenomenon and are most commonly seen secondary to obstructive ureteric calculi. These are usually diagnosed on barium enema or intravenous urography. Most of the times, more than one investigation is needed to confirm the findings. We present a case of iatrogenically-induced ureterocolic fistula, diagnosed on renogram and direct radionuclide cystography. This case showcases the possibility of using a renogram study as a diagnostic tool for a suspected ureterocolic fistula. A renogram study also enables to asess the renal function, which is essential in deciding the management.