Factors influencing the treatment outcomes of patients undergoing Urethroplasty for urethral stricture at Muhimbili national hospital

Abstract

ABSTRACT Background: Urethral stricture disease poses a substantial challenge in Sub-Saharan Africa, where the prevalence is notably high. This condition predominantly impacts men, and the underlying causes in the region are diverse and varied. There is a significant research gap in understanding the patient-related factors that contribute to the outcomes of urethroplasty for urethral strictures at Muhimbili National Hospital. Objectives: To determine the factors influencing treatment outcomes among patients undergoing urethroplasty for urethral stricture at Muhimbili National Hospital. Methodology: This cross-sectional analytical retrospective study was carried out at Muhimbili National Hospital. Through convenient sampling, data from the hospital’s patient database, specifically from patients aged 10 years and above, were extracted using a structured abstraction form. Patient information, clinical findings, treatment offered and treatment outcomes were collected. The collected data were analyzed using SPSS 23. Results: This study examined 126 patients with urethral stricture who underwent urethroplasty at MNH between January 2020 and December 2022. The mean age was 51 years, with the bulbar urethra being the most common stricture site (54%) and trauma the leading cause (44.4%). The comorbidities included diabetes (21.4%) and hypertension (71.4%). Most strictures were short (77%). Excision and primary anastomosis (EPA) procedures were preferred over buccal mucosal grafting (BMG) procedures (60.3% vs. 39.7%). The success rate of urethroplasty was 85.7%, with a 15.9% complication rate. Early complications included surgical site infections (54.5%), painful scrotum (36.4%), and wound dehiscence (9.1%). Late complications predominantly consisted of irritative lower urinary tract symptoms (83.3%), stress incontinence (5.6%), and erectile dysfunction (11.1%). Younger patients (<60 years) and those with infectious etiologies had significantly higher success rates. The type of vi stricture, length of stricture, surgical approach, and catheter type did not significantly impact outcomes. Conclusion: Urethroplasty had a high success rate of 85.7%, particularly in younger patients and those with infectious etiologies. Trauma was identified as the most common cause of urethral strictures, primarily affecting the bulbar urethra. Postoperative complications, both early and late, were observed, indicating the need for careful postoperative monitoring. Factors such as stricture level, length, surgical approach, and catheter type did not significantly impact the success of urethroplasty. Key words: Influencing factors, treatment outcomes, urethroplasty