Bladder neck stenosis—the value of descending cysto-urethrography in the demonstration of this complication of inflammatory urethral stricture

Attention is drawn to fibrotic stenosis of the bladder neck as a complication of inflammatory urethral stricture and ten cases with this complication in a series of 210 cases of urethral stricture are described. Descending cysto-urethrography is essential for the diagnosis and shows a narrow bladder neck instead of the normal funnel shape during the micturition of the contrast medium. In addition, there is usually gross reflux of contrast medium into the prostatic glands and severe bladder diverticulosis. Ascending cystourethrography may show a “jet” effect as the contrast medium enters the bladder. Cases of stricture with bladder neck stenosis have a higher incidance of other complications than those which do not show bladder neck stenosis which suggests that the development of the stenosis may be related to the severity of the stricture. The stenosis is due to fibrosis secondary to chronic infection of the bladder neck tissues. The source of the infection is presumed to be due to reflux of infected urine into the prostatic glands and this is always marked in cases with bladder neck stenosis. Treatment should consist of urethroplasty and resection of the bladder neck.