Early treatment outcomes of urethral Strictures at Moi Teaching and Referral Hospital – Eldoret, Kenya

Abstract

Background: Urethral strictures are a major challenge world over with tendencies to complications and recurrence even under the best of experts. A recent study conducted at Moi Teaching and Referral Hospital (MTRH) observed that urethral strictures were the leading cause of urological problems. Although urethral strictures are common at MTRH, there is still paucity of data on anatomical characteristics, comorbidities and early outcomes of their treatment. Description of anatomical characteristics, patient comorbidities and early outcomes will inform clinical practice and improve care of patients with urethral strictures. Objective: To determine modality-specific outcomes in management of urethral strictures at MTRH. Methods: This was a descriptive cross sectional census study from March 2018 through June 2019. All patients who had undergone urethral stricture surgery in the duration of study were approached for recruitment. A total of 65 patients consented for the study. The setting was in the urology in-patient unit of MTRH, a tertiary 1000 bed hospital in the Western region of Kenya. An interviewer administered questionnaire was used to collect data on comorbidities, postoperative complications, and patient reported satisfaction. Information on the characteristics of strictures and the modes of treatment was obtained from patient health records. Subjects were interviewed post-surgery at any point before discharge from hospital. The primary outcomes measured were modality of treatment of strictures, their early complications and patient reported satisfaction. Descriptive statistical analysis such as frequencies and percentages were used for categorical variables. Measures of central tendency such as mean and measures of spread such as standard deviation were used for continuous variables. Data was presented in graphs and frequency tables. Results: Majority of strictures 58(89.2%) were single site. The average stricture length was 2.6cm (SD ± 1.8). Bulbar urethral strictures were most common 40(52%) followed by Penile 31(40.3%). Common comorbidities were enlarged prostate (8.3%), erectile dysfunction (6.9%) and hypertension (6.9%). The main modality of urethral stricture treatment was urethroplasty in its various forms 66(84.6%). Anastomotic urethroplasty accounted for 52.6% of the procedures. Wound discomfort, scrotal pain and surgical site infection were the leading early outcomes of urethral stricture surgery. Anastomotic urethroplasty and staged urethroplasty had higher rates of complication than substitution urethroplasty. The overall rate of satisfaction at discharge from the ward was 80%. Conclusion: Anastomotic urethroplasty and staged urethroplasty had higher complication rates in the early post-operative period than direct visual internal urethrotomy or substitution urethroplasty. The overall patient satisfaction was good irrespective of modality used. Recommendations: Complication rates should be considered when counseling urethral stricture patients pre-operatively. Patient reported satisfaction should be routinely included as