Conference abstract
Outcome of excision and primary anastomosis in the management of short anterior urethral strictures in Yaoundé Central Hospital
Pan African Medical Journal - Conference Proceedings. 2023:17(101).04
Jun 2023.
doi: 10.11604/pamj-cp.2023.17.101.1749
Archived on: 04 Jun 2023
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Keywords: Urethral stricture, uroflowmetry, excision and primary anastomosis, cystourethrography
Oral presentation
Outcome of excision and primary anastomosis in the management of short anterior urethral strictures in Yaoundé Central Hospital
Mbassi Achille Aurèle1,&, Mbouche Landry2, Mekeme Mekeme Junior2, Kamga J3, Kamadjou Cyrille4, Esembe SM1, Epoupa Frantz Guy2, Fouda Jean Cedrick1,2, Owon’Abessolo Philip Fernandez1, Ndjom TSM5, Fouda Pierre Joseph1,2, Angwafo III Fru F2
1Central Hospital, Yaoundé, Cameroon, 2Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon, 3General Hospital, Yaoundé Cameroon, 4Gyneco-Obstetric and Pediatric Hospital, Douala, Cameroon, 5Higher Institute of Medical Technologies, Yaoundé, Cameroon
&Corresponding author
Introduction: urethral stricture is a reduction in the caliber of the urethra which impedes the free flow of urine. It is termed “short” when the narrowed segment is 2cm or less. The recommended management is direct vision internal urethrotomy (DVIU) or excision and primary anastomosis (EPA) for bulbar strictures. However, due to the limitations in DVIU, these strictures are often managed by EPA in our setting. This study was aimed at evaluating the outcome of EPA for short anterior urethral strictures at a referral hospital in Cameroon.
Methods: we carried out a retrospective, descriptive and cross-sectional study using medical records of patients who had undergone an EPA between January 2006 – 2016 (a 10-year period) in the urology department of the Yaoundé Central Hospital. Only completed patient files were included. Demographic, clinical and paraclinical parameters were described as well as the postoperative course. Success following EPA was defined by a maximum flow rate (Qmax) ≥ 15ml/s (excellent) or 10-14.9ml/s (good) at 6 months to 1 year post-op. The outcome was considered poor for flow rates <10ml/s.
Results: a total of 53 out of 98 medical files were eligible for our study. The mean age was 42.7 years (20-74 years) and the most affected age group was 20-40 years. The main etiologies of anterior urethral stricture were external trauma (49.1%), infection (26.4%) and urethral catheterization (20.8%). The most common clinical presentation was lower urinary tract symptoms and 43.4% of patients presented with acute urine retention. All patients had urine analysis/culture (positive in 56.6% of cases) and retrograde urethrography/antegrade cystourethrography. The stricture was located in the bulbar urethra in 64.2% of cases and a perineal incision was used for all cases of bulbar stricture. EPA was done using absorbable monofilament sutures (Monocryl or PDS 4-0 and 5-0). A silicon catheter (18 or 20 Fr) was maintained for 10-21 days. We had an early complication rate of 60.4% and a late complication rate of 11.3%. Our success rate based on uroflowmetry was 93.5% (Excellent = 78.3%, good = 15.2%).
Conclusion: urethral stricture affects mainly the young adult population and is mostly caused by external trauma. A minimum assessment (clinical and imaging) establishes the diagnosis. EPA has a good functional outcome in short bulbar urethral strictures.
Outcome of excision and primary anastomosis in the management of short anterior urethral strictures in Yaoundé Central Hospital
Mbassi Achille Aurèle1,&, Mbouche Landry2, Mekeme Mekeme Junior2, Kamga J3, Kamadjou Cyrille4, Esembe SM1, Epoupa Frantz Guy2, Fouda Jean Cedrick1,2, Owon’Abessolo Philip Fernandez1, Ndjom TSM5, Fouda Pierre Joseph1,2, Angwafo III Fru F2
1Central Hospital, Yaoundé, Cameroon, 2Faculty of Medicine and Biomedical Sciences, Yaoundé, Cameroon, 3General Hospital, Yaoundé Cameroon, 4Gyneco-Obstetric and Pediatric Hospital, Douala, Cameroon, 5Higher Institute of Medical Technologies, Yaoundé, Cameroon
&Corresponding author
Introduction: urethral stricture is a reduction in the caliber of the urethra which impedes the free flow of urine. It is termed “short” when the narrowed segment is 2cm or less. The recommended management is direct vision internal urethrotomy (DVIU) or excision and primary anastomosis (EPA) for bulbar strictures. However, due to the limitations in DVIU, these strictures are often managed by EPA in our setting. This study was aimed at evaluating the outcome of EPA for short anterior urethral strictures at a referral hospital in Cameroon.
Methods: we carried out a retrospective, descriptive and cross-sectional study using medical records of patients who had undergone an EPA between January 2006 – 2016 (a 10-year period) in the urology department of the Yaoundé Central Hospital. Only completed patient files were included. Demographic, clinical and paraclinical parameters were described as well as the postoperative course. Success following EPA was defined by a maximum flow rate (Qmax) ≥ 15ml/s (excellent) or 10-14.9ml/s (good) at 6 months to 1 year post-op. The outcome was considered poor for flow rates <10ml/s.
Results: a total of 53 out of 98 medical files were eligible for our study. The mean age was 42.7 years (20-74 years) and the most affected age group was 20-40 years. The main etiologies of anterior urethral stricture were external trauma (49.1%), infection (26.4%) and urethral catheterization (20.8%). The most common clinical presentation was lower urinary tract symptoms and 43.4% of patients presented with acute urine retention. All patients had urine analysis/culture (positive in 56.6% of cases) and retrograde urethrography/antegrade cystourethrography. The stricture was located in the bulbar urethra in 64.2% of cases and a perineal incision was used for all cases of bulbar stricture. EPA was done using absorbable monofilament sutures (Monocryl or PDS 4-0 and 5-0). A silicon catheter (18 or 20 Fr) was maintained for 10-21 days. We had an early complication rate of 60.4% and a late complication rate of 11.3%. Our success rate based on uroflowmetry was 93.5% (Excellent = 78.3%, good = 15.2%).
Conclusion: urethral stricture affects mainly the young adult population and is mostly caused by external trauma. A minimum assessment (clinical and imaging) establishes the diagnosis. EPA has a good functional outcome in short bulbar urethral strictures.
