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Background; Dilatation and direct vision urethrotomy are the most common procedures used by majority of urologist to manage urethral stricture disease. This includes urologists in both developed world as well as developing world.
Dilatation and direct vision urethrotomy are now regarded as neither cost effective nor efficacious as long term strategy for management of urethral stricture disease.
Despite the initial enthusiasm and good results reported by earlier studies, more recent studies have demonstrated a poor long-term success rate for direct vision urethrotomv.
Broad objective; The aim of this study is to document the late outcome of DVU as seen in patients with urethral stricture at KCMC.
Methodology; This is a hospital based retrospective cohort study that involved patients who presented to urology department at KCMC with urethral stricture and underwent direct vision urethrotomy from January 2006 to December 2013.
Results; A total of 648cases of urethral stricture disease were managed at KCMC between January 2006 and December 2013, out of these 365 (56.3%) underwent DVU and 283 (43.7%) underwent urethroplasty. Of the patients who underwent urethroplasty, 191(67.5%) underwent anastomotic urethroplasty, 64 (22.6%) underwent staged urethroplasty and 28 (9.9%) underwent substitutional urethroplasty. Out of 365 patients who underwent DVU during the study period 227 (62.2%) met the inclusion criteria, and 138 (37.8%) did not meet the inclusion criteria. Eighty six point four percent of participants were 40 years or older. One hundred and three participants (45.4%) had urethral strictures from iatrogenic causes. Most strictures were located in the bulbous part of urethra (63.9%). The majority of participants (66.1%) had strictures 1cm long or shorter. Most participants (90.8%) had a single stricture. Out of the 227 participants, 102 (44.93%) needed a re-operation. Of the 102 patients who required re-operation; 59 (57.84%) required the operation within six months; 18 (17.65%) within one year; 9 (8.82%) within two years; 12 (11.76%) within five years; and 4 (3.92%) required the operation beyond five years.
Conclusion;DVU is still the commonest treatment option for patients with urethral stricture at KCMC. Most patients (63%) who underwent DVU were 60 years or above.
The overall long term success rate of DVU was 55.07%
The outcome of DVU was good when stricture was single, the length was 1 cm or less and located in the bulbous urethra.
Recurrence of urethral stricture post DVU is significantly high for strictures which are long, multiple and located in other sites apart from bulbous urethra.
Age of the patient and etiology of the urethral stricture have no influence on the outcome of DVU
Key word; Urethral stricture, outcome |
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