Factors associated with recurrence of anterior urethral stricture following direct vision internal urethrotomy

Abstract

ABSTRACT Background: Anterior urethral stricture is a common urological condition that often requires surgical intervention, such as direct vision internal urethrotomy (DVIU), for treatment. Despite the initial success of DVIU, recurrence remains a significant concern. Identifying factors associated with recurrence of anterior urethral stricture can aid in patient management and improve outcomes. Objective: This study aims at determining factors associated with recurrence of anterior urethral stricture following DVIU among patients attending at Muhimbili National Hospital. Methodology: Between March 2018 and February 2023, a retrospective evaluation was conducted on 177 patients who underwent DVIU for urethral stricture. Data, including risk factors and preoperative workups were collected. Patients were divided into recurrence and non-recurrence groups based on postoperative outcomes, bivariate and multivariate analysis was done to compare association between sociodemographic factors, clinical factors and recurrence of anterior urethral stricture following DVIU. Results: In this study, 42 patients (24%) experienced stricture recurrence after DVIU, while 135 patients (76%) did not. Only patient age and stricture length had statistical significant association with recurrence of anterior urethral stricture following DVIU within five years of follow up. Patients with age of 60 years and above had higher chances of stricture recurrence following DVIU than younger ones. (p- value 0.04). The average age of patients with recurrence was 66±15 years, compared to 64±16 years. Recurrence occurred on average 2.6 months after DVIU, ranging from 1 to 49 months. The results indicated that stricture length above 1 centimeter (p-value < 0.001) exhibited statistically significant associations with recurrence of stricture. After adjusting for confounders, it was found that patient’s stricture length and age has an independent association with recurrence. As patients with strictures equal to 1 cm were five times [aOR=5.19 (2.36 - 11.41)] more likely to have recurrence compared to those with structure less than 1 cm, with the difference being statistically significant (p-value < 0.001) There was with no statistical significant difference between neutrophil count and neutrophil to lymphocyte ratio among patient recurrence and those without recurrence of anterior urethral stricture. Conclusion: The findings from this study demonstrated that older patients of age 60 years and above have higher chances of stricture recurrence than younger ones (p value 0.04) also patients with strictures equal to 1 cm are five times [aOR=5.19 (2.36 - 11.41)] more likely to have recurrence compared to those with stricture less than 1 cm, with the difference being statistically significant (p-value < 0.001). Keywords: Urethral stricture, Direct vision internal urethrotomy. Stricture recurrence, predictors of stricture recurrence.