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Introduction:
Urodynamic parameters (peak flow, pressure/flow, PVR) are often used during the evaluation of patients with urinary retention. Urethral stricture disease can demonstrate the same urodynamic picture as benign prostatic obstruction (BPO), potentially leading to incorrect management. In this study, we examine the radiographic parameters on voiding cystourethrogram (VCUG) and retrograde urethrogram (RUG) that identify stricture patients that have concurrent BPO.
Materials & Methods:
We reviewed 30 consecutive patients who underwent anterior urethroplasty; 15 with BPO and 15 without. BPO was diagnosed by urodynamics or symptomatic relief with an alpha-blocker. Radiographic characteristics on RUG and VCUG were evaluated by 2 independent reviewers.
Results:
Features associated with concurrent BPO included narrow bladder neck (BN) width on VCUG (mean 1.0cm vs. 1.8cm, p=0.0002), lower BN/prostatic length ratio (0.40 vs. 0.57, p=0.01), BN shape (concave vs. convex, p=0.003), narrowed prostatic urethra on RUG (p=0.016), bladder trabeculation/diverticula (p=0.0000003), PVR>180cc after VCUG (p=0.00006), and inability to complete VCUG (p=0.03). Factors not associated with concurrent BPO and urethral stricture included non-visualization of proximal urethra on RUG (p=0.063), enlarged bladder (p=0.12), and closed BN on VCUG (p=1.0). The multivariable model including BN width, BN shape, trabeculation/diverticula, and PVR showed each additional variable increasing the odds of having BPO 13.4-fold (p=0.009).
Conclusions:
Urethral stricture patients with urethrographic findings of narrow BN, low BN/prostatic length ratio, concave BN on VCUG, narrowed prostatic urethra, bladder trabeculation/diverticula, PVR>180cc, and inability to complete VCUG, should be counseled that they may need subsequent therapy to treat BPO in addition to their urethroplasty.