In developed countries, most urethral strictures generally have iatrogenic or idiopathic origin. Iatrogenic causes include urethral catheterization, cystourethroscopy, transurethral resection, and previous urethral surgeries. Other causes include idiopathic, trauma, infection/inflammation, and lichen sclerosus.

The initial evauation of uretral stricture is retrograde urethrography. It allows screening anterior urethra better but assesment of posterior uretra is limited. For screening posterior urethra commonlly voiding cystouretrograph is used. Combined this two procedure provides screening whole urethra.
The aim of this study is to show results of using alfa-blocker before performed combined voiding cystourethrography and retrograde urethrography.

Between December 2017 and February 2018 four patients whose urethrography was failed because of closed bladder neck enrolled this study. The reason of stricture was trauma in all patients and all of them had percutaneous cystostomy. We performed all patients combined retrograde and voiding cystourethrogram. When we didn’t observe posterior urethra gave an alfa blocker and 6 hour later repeat the test.

Mean age was 52.3 (27-63), man stricture lenght was 2.25 (1-4) cm. After using afla blocker two patients bladder neck was opened and combined screening of urethra was done succesfully. Two patients bladder neck was not opened and voiding cystouretrography didn’t performed.
Before (Figure 1) and after (Figure 2) using alfa blocker, combined uretrography screenings of same patient is shown in figures.

Presenting symptoms of urethral strictures often include decreased urinary stream, incomplete emptying, dysuria, infection, and a rising post void residual. Common risk factors for developing an urethral stricture include any transurethral surgery, pelvic and perineal trauma, urethral catheterization, prostate cancer treatment, a history of hypospadias repair, and lichen sclerosus.

Urethrography has been used for over 100 years in the diagnosis and staging of urethral stricture disease. In many ways, it remains the gold standard for this purpose.Typically, urethrography is performed in a retrograde fashion using 10-20 mL of radiocontrast agent. This is done after plain film imaging to document proper positioning and to assess for any concurrent radio-opaque urethral pathology.

Commonly after performed RUG should seek to identify 3 key features of a urethral stricture: the location of the stricture,  the length of the stricture, and the presence of any associated urethral pathology. Cystography can stage urethral strictures both in a dynamic and static fashion. After filling bladder mostly thin catheter or cystostomy  voiding cystourethrography can provide excellent assessment of the posterior urethra.


Combined this two procedure provides well screening entire urethra so stricture lenght and other concomitat disoerders are better determinied than perfoms only one. But when performed voiding cystouretrography after filling bladder bladder neck should be opened and radiocontrast agent moved trough the urethra. If bladder neck was not opened the procedure would be failed.

Alfa blockers have potentially reducing effects on bladder outlet or neck obstruction and improved voiding fuctions. So, These effects helps voiding cystouretrography after filling bladder.

Using alfa blocker may help opening bladder neck and improve voiding cystouretrography quality.