Current Clinical Spectrum and Management of Stricture Disease of Urethra: A Prospective Study PC01-PC04
Dr. Arpan Choudhary,
Room No. 36, KB Hostel, R G Kar Medical College Campus, Kshudiram Bose Sarani,
Bidhan Sarani, Shyambazar, Kolkata-700004, West Bengal, India.
Introduction: Stricture disease of urethra is widely prevalent throughout the world. However aetiology and management varies among different regions. Study of recent trend would help in better understanding of the disease.
Aim: To highlight the current clinical scenario and compare outcome of various treatment modalities for urethral stricture.
Materials and Methods: Prospective observational study included adult male patients of urethral stricture, admitted during March 2012 to September 2014. After history and examination, patients underwent uroflowmetry and post-void residual measurement, retrograde urethrogram and endoscopic evaluation. Treatment choice and outcomes were recorded. Patients were followed for a minimum of one year.
Results: Finally 110 patients were studied. Mean age was 38±15 years. Tobacco chewing and smoking was seen in 43.6% and 20.9% of cases respectively. Two-third of cases had obstructive urinary symptoms, while rests were brought in emergency with acute urinary retention or trauma, 18 cases had recurrent disease. Trauma was the most frequent cause(35.4%), followed by lichen sclerosis (23.6%). Most common site was bulbar region (36.4%), followed by external meatus (27.3%). For distal and pan-anterior strictures, substitution urethroplasty had higher success rate (100%) than urethral dilatation with steroids (60-70%). Anastomotic urethroplasty had durable outcome for bulbar strictures (88%), in comparison to internal urethrotomy (66%).
Conclusion: Young and middle aged patients were particular vulnerable for the stricture. Trauma, lichen sclerosis and infections were the leading causes. Bulbar region was the commonest affected site, with a rise in pan-anterior strictures. Open urethroplasty with or without graft had a clear edge over endourological procedures.