Determinants of Early Outcome of Surgical Management of Male Urethral Strictures in Rwanda: A Multicenter Study

Abstract

Background Male urethral stricture is the scaring of the subepithelial tissues of the corpus spongiosum, causing urethra lumen narrowing and a decrease in the urine stream. Urethral strictures etiological causes may be traumatic, inflammatory, or idiopathic. Trauma-related strictures are caused by straddle injuries or iatrogenic injuries. Stricture management has been cumbersome all over the world. About 10-20% of patients have stricture recurrence after surgery, requiring a redo surgery. There are scarce publications on stricture disease in Rwanda. This study was conducted to find out determinants of the short-term outcome of surgically managed male urethra strictures in Rwanda.

Patients and Methods This is a retro prospective, analytical study conducted in 4 Rwanda referral hospitals with urology services. All male patients with urethral stricture operated on in the 4 study hospitals from January 2019 to April 2021 were involved. Retrospective data were retrieved from patients' files from hospital archives, electronic database systems, while prospective data were recorded during consultation, surgery, and in OPD follow-up until 3 months after surgery. The predictors were demographic, preoperative clinical characteristics, perioperative details, and postoperative outcome. The main outcome was stricture recurrence at 3-month post-operative. A CUG and or a 16Fr Foley catheter was used, the recurrence was defined as visible stricture on CUG image or inability to pass a 16Fr Foley catheter without difficulties. Data were analyzed using SPSS V.21, bivariate and multivariate analyses were done to identify the determinants.

Results and limitations A total number of 112 male patients were enrolled. The patients’ mean age was 42 years, the median age was 42 years (SD=17.201). The mean stricture length was 1.63 cm. Most of the strictures 71.4% were located in the bulbar segment. Twenty (17.9%) patients had a recurrence. Both bivariate and multivariate analysis showed a stricture length of >2 cm to be the only independent value determinant of recurrence.

Conclusions Urethral stricture disease is a condition of young adults; the stricture length of >2 cm was found to be the only determinant of recurrence. Extended studies need to be done to clarify other determinants of recurrence.