Urethral Stricture and HIV: Unusual Presentations and Treatment Challenge

Abstract

Objective: The clinico-pathologic features of urethral stricture in patients with HIV/AIDS are not yet clearly described in the literature. HIV/AIDS has changed the natural course and clinical features of most infectious diseases. We describe some of the features of post-inflammatory strictures associated with HIV Infection and assess the treatment challenges and outcomes of other causes of urethral stricture.
Patients and Methods: Consecutive men with urethral stricture who presented to the University Hospital of Gondar, North-West Ethiopia were enrolled. The HIV status, cause of the stricture, type of treatment and outcome were recorded.
Results: There were 25 post-traumatic and 15 post-gonococcal urethral strictures. All posttraumatic and 5 of the post-gonococcal urethral stricture patients were HIV negative. All 10 HIV positive patients had longer and denser urethral strictures than expected. The time between gonococcal infection and urethral stricture development was 3-5 years in HIV positive patients. The treatment of post-traumatic stricture included progressive perineal anastomotic urethroplasty and a good outcome was seen in more than 95%. However, the surgical treatment of patients with HIV infection was a challenge.
Conclusion: If post-inflammatory urethral stricture occurs in a young man where the time between known gonococcal infection and development of stricture is short (less than 5 years), HIV coinfection is most likely. The stricture in these patients will be longer and denser and not amenable
to conventional endoscopic urethrotomy.

Key Words: Urethral stricture, gonococcal infection, trauma, treatment, HIV