Demographics, Clinical Presentation, Management and Outcome of Patients with Urethral Stricture in Qassim Region

Badr Alharbi, Emad Alwashmi, Hatim Alnosayan, Faisal Awadh Al-Harbi, Saleh Abdulrahman Alwashmi, Abdulaziz Ibrahim Alkhudhayri, Saif Fahad Alharbi, Adil Khalaf Altwairgi

 
For citation: Alharbi B, Alwashmi E, Alnosayan H, Al-Harbi FA, Alwashmi SA, Alkhudhayri AI, Alharbi SF, Altwairgi AK. Demographics, Clinical Presentation, Management and Outcome of Patients with Urethral Stricture in Qassim Region. International Journal of Biomedicine. 2024;14(4):602-606. doi:10.21103/Article14(4)_OA11
 
Originally published December 5, 2024
 

Abstract: 

Background: Urethral stricture (UrS), a narrowing of the urethra, is caused by many etiologies and can vary in severity. This condition can lead to various urinary symptoms and complications, resulting in emergency room visits and hospital admissions. This study aimed to assess the demographics, clinical characteristics, management, and outcomes of people with urethral stricture in the Qassim Region of Saudi Arabia.
Methods and Results: This retrospective study included all cases of urethral stricture treated at King Fahd Specialist Hospital (KFSH), Buraydah, Saudi Arabia, between October 2017 and July 2024. The complete records of 90 UrS patients of all ages were analyzed. The study recorded the age, clinical characteristics, management, and outcomes of UrS patients. All patients were male.
The mean age of the patients was 41.13±16.61 years, with 55.6% under 41. In most of the cases (95.6%), urethral strictures were symptomatic, commonly presenting lower urinary tract symptoms (LUTS) (87.2%), followed by urinary tract infection (UTI) (3.4%), acute urine retention (2.3%), and dysuria (2.3%). Regarding the cause, most cases were found to be idiopathic (81.1%), followed by post-infectious causes (6.7%) and traumatic causes (5.6%). Iatrogenic causes were identified in only two patients (2.2%), as well as urethral stones in 2(2.2%) patients. Most strictures occurred in the bulbomembranous region of the urethra (83.5%). Regarding treatment modalities, visual internal urethrotomy was done for 82(91.2%) patients and follow-up for 3(3.3%) patients. In most cases, 64.4% of strictures were successfully treated, while the strictures recurred in 35.6% of patients.
Conclusion: Urethral stricture disease was common among males under 41 who presented with LUTS and UTI to King Fahd Specialized Hospital. Most of the cases were idiopathic, followed by post-infectious causes and traumatic causes, and most of the strictures occurred in the bulbomembranous urethra. Visual internal urethrotomy is commonly used for both visualization and treatment of urethral stricture. The study highlights the importance of using modern technology to facilitate a comprehensive and systematic approach to understanding the underlying pathology of urethral stricture. It is particularly important to rule out other potential causes, especially when there was no apparent cause initially.

Keywords: 
urethral stricture • urinary tract infection • lower urinary tract symptoms
References: 
  1. Lumen N, Campos-Juanatey F, Greenwell T, Martins FE, Osman NI, Riechardt S, Waterloos M, Barratt R, Chan G, Esperto F, Ploumidis A, Verla W, Dimitropoulos K. European Association of Urology Guidelines on Urethral Stricture Disease (Part 1): Management of Male Urethral Stricture Disease. Eur Urol. 2021 Aug;80(2):190-200. doi: 10.1016/j.eururo.2021.05.022. Epub 2021 May 29. PMID: 34059397.
  2. Bayne DB, Gaither TW, Awad MA, Murphy GP, Osterberg EC, Breyer BN. Guidelines of guidelines: a review of urethral stricture evaluation, management, and follow-up. Transl Androl Urol. 2017 Apr;6(2):288-294. doi: 10.21037/tau.2017.03.55. PMID: 28540238; PMCID: PMC5422698.
  3. Fenton AS, Morey AF, Aviles R, Garcia CR. Anterior urethral strictures: etiology and characteristics. Urology. 2005 Jun;65(6):1055-8. doi: 10.1016/j.urology.2004.12.018. PMID: 15913734.
  4. Tritschler S, Roosen A, Füllhase C, Stief CG, Rübben H. Urethral stricture: etiology, investigation and treatments. Dtsch Arztebl Int. 2013 Mar;110(13):220-6. doi: 10.3238/arztebl.2013.0220. Epub 2013 Mar 29. PMID: 23596502; PMCID: PMC3627163.
  5. Almhmd AE, Almujel KN, Alruwaili MA, Kaseb AMA, Alaenzi YA, Alhashem FA, et al. Causes and Management of Urethral Strictures in Elderly: A Review. J Pharm Res Int. 2021 Aug 10;120–5.
  6. Basaif WS, Alamri HH, Mousa HW, Alsayed RA, Almohammadi AM, Altulayqi WH, et al. Types of urethral stricture and their recurrence rates post urological treatments. Int J Community Med Public Health. 2021 Jun 25;8(7):3634.
  7. Alwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014 Jun;3(2):209-13. doi: 10.3978/j.issn.2223-4683.2014.04.07. PMID: 26813256; PMCID: PMC4708169.
  8. Almannie R, Alturki A, AlSufyani A, Alkhamis W, Binsaleh S, Alyami F. Exposure of Urology Residents to the Management of Urethral Strictures in Saudi Arabia: Should the Program for Postgraduates Be Customized? Res Rep Urol. 2020 Sep 8;12:367-372. doi: 10.2147/RRU.S268628. PMID: 32984084; PMCID: PMC7490046.
  9. Al Khayal AM, Bin Mosa MA, Alrabeeah KA, Abumelha SM. Adult urethral stricture: Practice and expertise of urologists in Saudi Arabia. Urol Ann. 2019 Oct-Dec;11(4):393-398. doi: 10.4103/UA.UA_159_18. PMID: 31649460; PMCID: PMC6798308.
  10. Almannie RM, Alkhamis WH, Alshabibi AI. Management of urethral strictures: A nationwide survey of urologists in the Kingdom of Saudi Arabia. Urol Ann. 2018 Oct-Dec;10(4):363-368. doi: 10.4103/UA.UA_58_18. PMID: 30386087; PMCID: PMC6194796.
  11. Anger JT, Buckley JC, Santucci RA, Elliott SP, Saigal CS; Urologic Diseases in America Project. Trends in stricture management among male Medicare beneficiaries: underuse of urethroplasty? Urology. 2011 Feb;77(2):481-5. doi: 10.1016/j.urology.2010.05.055. Epub 2010 Dec 18. PMID: 21168194; PMCID: PMC3320109.
  12. Schwender CE, Ng L, McGuire E, Gormley EA. Technique and results of urethroplasty for female stricture disease. J Urol. 2006 Mar;175(3 Pt 1):976-80; discussion 980. doi: 10.1016/S0022-5347(05)00336-8. PMID: 16469596.
  13. Singh O, Gupta SS, Arvind NK. Anterior urethral strictures: a brief review of the current surgical treatment. Urol Int. 2011;86(1):1-10. doi: 10.1159/000319501. Epub 2010 Oct 19. PMID: 20956850.
  14. Lepor H. Pathophysiology of lower urinary tract symptoms in the aging male population. Rev Urol. 2005;7 Suppl 7(Suppl 7):S3-S11. PMID: 16986059; PMCID: PMC1477625.
  15. Lazzeri M, Sansalone S, Guazzoni G, Barbagli G. Incidence, causes, and complications of urethral stricture disease. European Urology Supplements. 2016 Jan 1;15(1):2-6.
  16. Wessells H, Morey A, Souter L, Rahimi L, Vanni A. Urethral Stricture Disease Guideline Amendment (2023). J Urol. 2023 Jul;210(1):64-71. doi: 10.1097/JU.0000000000003482. Epub 2023 Apr 25. PMID: 37096574.
  17. Lee YJ, Kim SW. Current management of urethral stricture. Korean J Urol. 2013 Sep;54(9):561-9. doi: 10.4111/kju.2013.54.9.561. Epub 2013 Sep 10. PMID: 24044088; PMCID: PMC3773584.
  18. Nwofor AME, Ugezu AI. Urethral stricture management. Experienceat Nnewi South East Nigeria. Afr J Urol 2004;10(2):107–11.
  19. Ahmed AB. Substitution Urethroplasty in the Management of Anterior Urethral Stricture Disease-a Study of 50 Cases. Saudi J Med. 2020;6(6):169-75.
  20. Alathel A, Alfraidi O, Alsayyari ASA, Aljaafri B, Alsalamah F, Almeneif H, Alsaif A. Exploring the incidence and characteristics of urolithiasis in the central region of Saudi Arabia: Insights from a prominent medical center. Urol Ann. 2024 Jul-Sep;16(3):233-240. doi: 10.4103/ua.ua_1_24. Epub 2024 Jul 3. PMID: 39290225; PMCID: PMC11404719.
  21. Al Darrab R, Addar AM, Al Shohaib I, Ghazwani Y. Trends of upper urinary tract stone management in a high volume stone center in Saudi Arabia, 12 years analysis. Urol Ann. 2020 Apr-Jun;12(2):128-131. doi: 10.4103/UA.UA_49_19. Epub 2020 Apr 14. PMID: 32565649; PMCID: PMC7292426.
  22. Blaschko SD, McAninch JW, Myers JB, Schlomer BJ, Breyer BN. Repeat urethroplasty after failed urethral reconstruction: outcome analysis of 130 patients. J Urol. 2012 Dec;188(6):2260-4. doi: 10.1016/j.juro.2012.07.101. Epub 2012 Oct 22. PMID: 23083654; PMCID: PMC3565597.

Download Article
Received October 11, 2024.
Accepted November 10, 2024.
©2024 International Medical Research and Development Corporation.