Prostatic Urethral and Vesical Synechiae Secondary to Recurrent Urinary Tract Infection and Bladder Outlet Obstruction: An Intraoperative Surprise for the Urologist

Synechiae are intracavitary adhesions rarely reported in the urological literature. To date, very few cases of ureteral and vesical synerchiag (after urological surgery) have been reported. We report a rare case of prostatic urethral and vesical synechiae secondary to recurrent urinary tract infection (UTI). This was incidentally diagnosed on cystoscopy. A patient with known case of diabetes mellitus and ischemic heart disease presented with storage and voiding lower urinary tract symptoms. He had left epididymoorchitis and recurrent UTI. Investigations showed a left solitary functioning kidney with hydronephrosis and small capacity bladder. He had leucocytosis, raised serum creatinine, and positive urine culture. Under antibiotic cover, he was planned for cytoscopy left Double J (DJ) stenting. During cytoscopy, the patient had a short segment bulbar urethral stricture, which was managed with optical internal urethrotomy. Multiple bladder and prostatic urethral synechiae were found along with bladder diverticula and small bladder capacity. The left ureteric orifice was identified at 1-o'clock. Retrograde pyelography showed an upper ureteric kink and DJ stenting was difficult. The patient improved clinically and is under follow-up. Till date, retained suture material due to urological surgery has been identified as the cause of synechiae. However, our patient didn't have a history of surgery. No foreign material was identified during cystoscopy. Hence, we postulate that recurrent UTI and bladder outlet obstruction (stricture urethra) contributed to the development of synechiae. Laser incision of synechiae is recommended as the treatment. Keywords: Urology, synechiae, urinary tract infection