Short segment bulbar urethral strictures: Review of 48 cases managed in a resource-poor setting

Abstract

Objective: To share our experience on the presentation and management of short segment bulbar urethral strictures (BUSs) in a resource-poor center.

Methods: Short segment bulbar urethral strictures (BUSs) managed from January 2009 to December 2014 were analyzed. Patients’age, stricture aetiology, mode of presentation, stricture characteristics, time to surgery, associated morbidity, operative procedure, and post-operative outcome were reviewed. All patients had bulbar anastomotic urethroplasty (BAU).

Results: Total 42 bulbar anastomotic urethroplasties (BAUs) were done. The mean age of the patients in years was 37.46 (± 13.80). Fall astride injuries accounted for most strictures, 39(89.3%) of cases. The mean stricture lenght was 1.04 cm ± 0.49 and was longer in patients who had prior instrumentation,1.45 cm (± 0.37) versus 0.70 cm (± 0.26), P = 0.000. Associated lower urinary tract comorbidities were noted in 38 (79.2%) patients. Mean time to surgery was 10.20 (± 4.96) months. Patients operated on after 6 months of presentation had more associated comorbidities, 24/26 patients (92.3%), compared to those operated on within 6 months; 8/16 cases (50%), P = 0.003. However, this did not impact negatively on the outcome of surgery (P = 0.275). Patients with complete strictures tended to accept surgery earlier than those with incomplete strictures, 29 patients (60.4%) versus 19 patients (39.6%), P = 0.208,with no difference in outcome between the two groups, P = 0.581. The overall success rate was 92.9%.

Conclusions: Fall astride injuries are the commonest cause of short segment BUSs. Prior urethral instrumentation is associated with recurrence and longer stricture lenght. Suprapubic catheter-related associated comorbidity increases with the duration of catheterization but does not impact negatively on the surgical outcome. BAU has low morbidity and high success rate of 92.7%. It should be the first line treatment for short segment BUS in low-resource countries.

Keywords: Anastomotic urethroplasty, resource-poor setting, short segment bulbar urethral stricture