“Close-loop” urethral obstruction: Clinico-radiological features and management consideration in a resource-constraint environment

Abstract

Objective: To document our observation of “close-loop” obstruction among patients with dual urethral obstruction from BPH and urethral stricture disease. Materials and Methods: The hospital records of all patients that presented to our centres with evidences of urethral stricture co-existing with BPH were retrospectively reviewed from January 2007 to December 2011. Among other things, the salient features in the contrast radiograph of those with “close-loop” obstruction and their treatment were documented and analysed. Results: Forty three patients were managed for radiological evidence of urethral stricture and elevated bladder base (dual obstruction). Thirty (69.7%) of these patients had open prostatectomy with easy dilatation of the urethral stricture. Twelve (27.9%) of the patients had urethroplasty for urethral stricture diseases; of these twelve, five patients presented with persistent LUTS (“close loop” obstruction). These five (11.6%) patients were aged between 50 to 80 years; they all had suprapubic cystostomy. In addition to delineating the anatomy of the urethral stricture and elevated bladder base, other salient features on the contrast radiographies included dilated prostatic urethral, visualization of the seminal vesicles and closed bladder neck on voiding cystogram. The initial treatment was urethroplasty but two each had combination therapy (with alpha adrenergic blocker and 5-alpha reductase inhibitor) and open prostatectomy respectively as further treatment while the last patient had perineal urethrostomy as first-stage redo-urethroplasty. Conclusion: “Close-loop” urethral obstruction appears to be an entity that needs further evaluation.

Keywords

• Benign prostate hyperplasia
• Close-loop urethral obstruction
• Retrograde urethrogram
• Urethral stricture disease
• Voiding cysto-urethrogram