Pattern of Presentation and Management of Male Urethral Strictures in A Resource-Limited Community: Challenges and Outcome

Abstract

Background: Urethral stricture is an unnatural narrowing or loss of urethral compliance due to spongiofibrosis that leads to bladder outflow obstruction. Its management is still a great challenge in our region.

Objectives: To share our experience about urethral strictures managed in a rural tertiary health center in Nigeria.

Method: Retrospective study of urethral strictures managed over 5-year period at a tertiary health center in Nigeria. Only Patients that had surgical procedures for urethral stricture with at least one post-op follow-up were included. Age, stricture characteristics, and treatment outcome were analyzed.

Results: Only 74 out of 91 patients have complete records, hence selected and studied. Their mean age was 49.66yr (±19.41), the principal symptom was a weak urinary stream (86.49%), with acute urine retention in 56.76%. Suprapubic cystostomy was done in 77.03%. The strictures were post-inflammatory (60.81%), Post-traumatic (27.03%) and recurrent (10.81%). The strictures were predominantly bulbar (55.41%). The median duration of symptoms to the time of presentationwas 135 days. Majority (55.41%) had anastomotic urethroplasty. Post-op complications were seen in 43.24%. Most patients (77.03%) had no significant lower urinary tract symptoms at a median (interquartile range) of 58days (37 to 135) postoperative period. There was a significant improvement in median international prostate symptom score at 6 weeks, 6 months, and 1 year after surgery compared to pre-operative symptoms.

Conclusion: Financial constraints, inadequate facilities and specialists are the major challenges. Increased patients’ health awareness, universal (free or subsidized) healthcare coverage may help in alleviating some of the challenges.