Urethrographic patterns of urethral strictures among patients with micturition abnormalities at Muhimbili National Hospital

Abstract

Background: Urethral stricture is a global health problem mainly occurring among males with history of pelvic trauma and urinary tract infections which normally is associated with various voiding problems ranging from urinary incontinence to complete obstruction. Urethrography is the most important imaging modality for urethral stricture and can help in planning of its management. Broad objective: To determine urethrographic patterns of urethral strictures among patients with micturition abnormalities at Muhimbili National Hospital from June to December 2016. Methodology: This was a descriptive cross sectional study that was conducted at radiology department MOI involving 145 patients with micturition abnormalities who were referred and had consented for urethrogaphy examination during the period of study. Convenience sampling method was used. Structured questionnaires were used for data collection and imaging findings recorded. Data analysis was done using the Statistical Package for Social Sciences (SPSS) version 20. and a p-value of < 0.05 was considered statistically significant. Statistical association between urethral stricture patterns and various associated aetiological factors such as trauma, iatrogenic, congenital and inflammatory causes was done using cross tabulations and CHI-square test was used to compare proportions. Urethral stricture was the dependent variable while the urethral stricture causes such as trauma, inflammatory, congenital and iatrogenic causes were the independent variables. Results: This study involved 145 patients with micturition abnormalities who were refered to MOI radiology department .All patients were males. The median age was 65 years with age range of 86(1-87) and standard deviation of 24.56 for the mean age of 55.72 years [P=0.0002]. Many patients with Urethral stricture were above 60 years old 63(58.9%).Obstruction was a major symptom with which most patients presented(63.4%). Urethral catheterization appeared to be the dominant indication with which patients who were reffered for urethrography presented ie 53(36.6%) patients with [P=0.0001] followed by infections 20 (18.7%), trauma 20 (18.7%) and post prostatectomy strictures in 19 (17.8%) patients. The results show that among the anatomic patterns of urethral strictures, bulbous urethra was the most commonly involved anatomic site(54.5%) followed closely by membranous urethra(41.5%) and by far the penile(9.9%) and last was the prostatic urethra(2%). Most of patients found to have urethral strictures had short segment strictures (82%). The results revealed that most of the patients with urethral strictures presented with smooth mucosal pattern(76.6%) rather than irregular pattern(17.8%). Most of patients presented with single stricture(88.1%) rather than multiple(11.9). The study also showed statistically significant correlation between post urethral catheterization and bulbous urethral strictures( r = 0.340 and p=0.0001) that are smooth [r=0.349, p=0.001] and of short segment. [r=0.227,p=0.022]. Trauma is shown to have significant correlation with membranous, [r=0.488, p=0.0001] long segment [r=0.308, p=0.002] as well as mixed type of urethral stricture patterns.[r=0.201, p=0.044]. Conclusion: Urethral stricture disease is a predominantly male disease. Most of patients with urethral stricture are above 60 years of age. Bulbous urethra is the most commonly involved anatomic site. Urethral catheterization is a leading cause of urethral stricture in patients above 60 years. Infections are still a significant cause of urethral stricture in our communities. Recommendation: All patients aged 60 years and above presenting with lower urinary tract symptoms should undergo urethrogram procedure to rule out urethral stricture disease provided prostate enlargement has been ruled out as a cause. More research on assessment of urethral stricture patterns.