The pattern, treatment options and early treatment outcomes of urethral stricture at Muhimbili national hospital and Tumaini hospital, Dar es Salaam.

Abstract

Introduction: In Europe, urethral stricture is mentioned in writings dating back to the time of Socrates, Epicurus and Celsus. Its modern definition is fixed anatomical narrowing between bladder neck and the external urethral meatus usually to less than 14F gauge and preventing urethral catheterization. Urethral stricture is a common condition in both developed and developing countries, but the pattern of causes in the two situations are different. Urethral Stricture can occur in female as well as in male, but it is far commoner in the male urethra for various anatomical and pathological reasons. Urethral stricture according to the literature may be congenital, iatrogenic, traumatic or inflammatory. Broad objective: To determine the pattern, treatment options and early treatment outcomes of urethral stricture among patients seeking urological services at Muhimbili National Hospital and Tumaini Hospital, Dar es salaam. Methodology: The study was conducted at MNH, which is the national referral hospital and Tumaini Hospital which is one of the prominent private hospital with urology bias. This was a hospital based descriptive, prospective study which involved all patients presenting to urology clinics confirmed to have urethral strictures during the period of study from March 2011 to December2011. Results A total of 111 patients with urethral strictures were recruited into the study, 69 patients were from Muhimbili National Hospital (MNH) and 42 patients were from Tumaini Hospital. All were male with mean age of 52.7 years, and age range from 10 years to 97 years. Trauma was the commonest cause of urethral stricture among patients in age group below 45 years (64.2%) with a mean age of 38.48 years ( p=0.000) . Urethral catheterization was the commonest cause of urethral stricture among patients in age group above 45 years (80.9%) vii [p= 0.026]. Eighty six were strictures of bulbar urethra which accounted for 63.2% of all strictures. DVIU constituted 64% of the provided treatments. Conclusions Urethral stricture disease remains a predominantly male disease covering a wide range of ages of patients. Iatrogenic and accidental traumas are the commonest causes of urethral stricture cutting across all the age groups. The bulbar urethra remains the commonest site of urethral stricture. DVIU was the commonest mode treatment of patients with urethral stricture seeking urological services at Muhimbili National Hospital and Tumaini Hospital in Dar es Salaam. Treatment outcomes were almost the same for the different options of treatment. However, primary urethroplasty had better outcome than DVIU during the follow up of 3months. Recommendation Continuing medical education should be given to health workers all over the country on proper handling of patients with urethral injuries. Urethral catheterization should be made a safe and sterile procedure which should be individualized as per need. Patients with urethral stricture should be handled by the experienced urologist due to complexity in its management to reduce complications and improve treatment outcome. Proper documentation and long term follow up of patients with urethral stricture disease should be insisted in order to have good outcome.