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Have our strictures changed? Analysis of Current Characteristics and Management of Urethral Stricture Disease in Zaria, Nigeria


 Introduction:
 Urethral stricture is a common cause of lower urinary tract symptoms in the middle aged and elderly men. Its presentation and management is closely linked with its etiology and this varies across geographical regions of the world as well as over time.
We hereby review the etiology, characteristics and presentation of men with urethral strictures in a tertiary hospital in northern Nigeria over a year and compare it with previous studies in the region.
Patients and Methods
The study was a prospective study from January-December 2016, all patients with urethral strictures and who consented to the study were enrolled into the study. Data was collected using a structured study profoma and analyzed using SPSS version 23.
Results
The mean age was 44.1 years with a range of 13-71 years. The bulbar urethra was the site of most strictures with a frequency of 65%. The etiology was infection in majority of the patients with a frequency of 53.3%. Post traumatic strictures occurred in 33.3% while iatrogenic and catheter –Induced strictures were seen in 7.1% and 6% respectively. 88% had no previous intervention for the stricture prior to presentation.The complications from urethral strictures observed in the patients were acute urinary retention in 83.4% urethrocutaneous fistulae in 2.4% and urosepsis in 1.2% of the patients. 11% presented with no complication.68% of these patients were managed by excision and end to end anastomosis, 15 % had a penile pedicled flap 12% , a buccal mucosa graft urethroplasty and 5% with staged urethroplasty
The trends in etiology of urethral stricture disease in the region reported is: Ahmed etal in zaria (1990) Infection accounted for 66.50% , post traumatic stricture 31.50%. Ntia et al Sokoto (2006)found infection as aetiology in 44.70% and post-traumatic strictures in 47.40%. Ofoha et al in Jos however found Infection in 53.30% and post traumatic 40.30%
Conclusion
Though there is a gradual rise in post-traumatic and iatrogenic strictures in our environment, Post inflammatory strictures still predominates. It is however infrequently accompanied by fistulae as seen decades ago. These strictures are mostly long segments single bulbar strictures