retrograde urethrogram ( rgu ) and voiding cystourethrogram ( vcug ) are used to define the length and location of urethral stricture prior to surgery . in patients with pelvic fracture urethral distraction defect ( pfudd ) , the bladder neck sometimes fails to open on vcug , leading to erroneous estimation of the stricture length .
these patients are often on prolonged suprapubic diversion , which leads to decreased bladder capacity and inability to open the bladder neck .
silodosin is an alpha-1a - adrenoceptor selective antagonist that has been shown to increase urinary flow rates within 2 - 6 hours ( 1 ) .
we used a single dose of silodosin ( 8 mg tablet ) before vcug to relax the bladder neck and achieve excellent visualization of the posterior urethra .
  our objective was to evaluate the efficacy of silodosin in improving visualisation of posterior urethra during vcug and compare our results with a control group .
this study was carried out in a prospective manner from january 2013 to july 2013 among patients with post - traumatic urethral stricture on suprapubic cystostomy who attended the urology outpatient department .
patients with partial disruption of the urethra ( passing urine per urethra ) , straddle injury , anterior urethra stricture , and severe cardiac , hepatic , or renal disease were excluded from the study .
the patients were divided into group a and group b containing 20 and 15 patients , respectively .
the patients in group a were given a single dose of silodosin ( 8 mg ) 3 hours prior to radiological studies .
rgu and vcug were performed in the radiology suite with antiseptic precautions with the patient in an oblique position .
a 5-fr infant feeding tube was placed in the fossa navicularis , and 15 - 20 ml of contrast ( meglumine iothalamate , tazograf ) was injected for the rgu .
about 300 - 400 ml of diluted contrast ( 60:40 contrast : normal saline ) was used .
thirty - five men , divided into group a ( n = 20 ) and group b ( n = 15 ) , were evaluated during the study period .
the average age of the patients was 29.1 years ( range = 22 - 45 ) in group a and 32.4 years ( range = 20 - 41 ) in group b. in group a , 19 out of the 20 patients were able to achieve satisfactory opening of the bladder neck , while in group b , 10 out of the 15 patients were able to open the bladder neck .
the results were analyzed using a paired t - test ( 95% confidence interval , p = 0.027 ) .
a combined rgu and vcug has remained the bedrock of the diagnosis of urethral stricture , although both magnetic resonance urethrography and urethral ultrasound have been shown to be superior ( 2 ) .
a poorly performed urethrogram leads to an incorrect estimation of the stricture length ( 3 ) .
sometimes the bladder neck fails to open on vcug , which leads to an erroneous estimation of the stricture length .
the evaluation of the posterior urethra is extremely important in pfudd patients as this a critical factor determining the success of surgical procedures .
the disruption of urethral continuity as well as the presence of hematoma and spongiofibrosis in the surrounding tissues can give rise to the wide separation of the urethral ends .
although a static cystogram has been regarded as a sign of an intact bladder neck , this finding can be misleading .
these patients are often on prolonged suprapubic diversion , which results in decreased bladder capacity and inability to tolerate sufficient bladder distension to open the bladder neck voluntarily .
a technique of passing a curved urethral sound antegrade from the suprapubic tract into the posterior urethra has been described to identify the proximal limit of stricture . however , this can cause bleeding and bladder neck injury ( 4 ) .
it uses t1 and t2 echo - weighed spin sequences after the distension of the urethra with a sterile lubricating jelly .
its disadvantages include its limited availability and the high cost of the investigation ( 4 ) .
the examination is performed after the instillation of sterile saline into the urethra using 7.5-mhz probes .
the probe is placed on the ventral surface of the penis to evaluate the penile and bulbar urethra .
a further limitation is the high degree of technical expertise required for the scan as most radiologists do not routinely perform this investigation ( 5 ) .
the antegrade urethrogram technique has been described to visualize the proximal bulbar urethra in anterior urethra stricture patients .
an optical cystoscope is passed antegrade via the suprapubic cystostomy tract into the posterior urethra , and a ureteric catheter is used to inject the contrast prior to imaging .
this technique is not useful to evaluate the posterior urethra because the contrast rapidly passes into the bladder without entering the posterior urethra .
silodosin is an alpha-1a - adrenoceptor antagonist used for the treatment of the lower urinary tract symptoms associated with benign prostatic hyperplasia .
it relaxes the bladder neck and prostatic urethra and has been shown to increase the urinary flow rates 2 - 6 hours after the first dose ( 1 ) .
it is associated with a high degree of affinity for the 1a subtype of alpha - adrenoceptors , predominantly located in the prostate and lower urinary tract .
silodosin is associated with a low incidence of side effects ( e.g. orthostatic hypotension and retrograde ejaculation ) due to its selective action ( 7 , 8) .
the ingestion of a single dose of silodosin led to a statistically significant increase in the bladder neck opening in our study .
this leads to multiple fluoroscopic images being obtained with increase in the radiation exposure of the patient .
silodosin circumvents these problems by opening the bladder neck and ensuring the flow of the contrast into the posterior urethra . in our cohort of patients ,
silodosin use prior to vcug conferred a statistically significant increase in the visualization of the posterior urethra and was safe with no adverse effects .
 background : retrograde urethrogram and voiding cystourethrogram are used to define length and location of urethral stricture prior to surgery . 
 we used a single dose of silodosin prior to vcug to relax the bladder neck and achieve visualization of posterior urethra.objectives:to evaluate the efficacy of silodosin in visualization of posterior urethra during vcug , and to compare the findings with a control group.patients and methods : patients were divided into two groups a and b containing 20 and 15 patients , respectively . 
 patients in group a were given a single dose of silodosin prior to radiological studies.results:in group a 19 out of 20 patients were able to achieve satisfactory bladder neck opening while in group b 10 out of 15 patients were able to achieve bladder neck opening.conclusions:silodosin use prior to vcug confers a statistically significant increase in bladder neck opening and visualization of posterior urethra . 
1. Background
2. Objectives
3. Patients and Methods
4. Results
5. Discussion