Orandi flap for penile urethral stricture: Polishing the gold standard

Urethral Stricture and Urethroplasty Practice in a Teaching Hospital in Anambra, South-Eastern Nigeria

Background

Management of urethral stricture disease remains a challenge in the field of urology. Though several options exist for its management, urethroplasty has proved to give the best outcome.

Methodology

This is a retrospective study of urethral strictures and urethroplasties for 5years spanning from January 2015 to December 2019 at a tertiary teaching hospital in Anambra, South East Nigeria. Data was retrieved from the case notes of all the urethral strictures cases which presented to our facility in these 5 years and analysed using Microsoft Excel.

Results

A total of 186 patients were diagnosed with urethral stricture disease within the 5 years' period. However, only 28 (15.1%) of them had urethroplasty within the period, mostly due to lack of fund. Of those who had urethroplasty, their ages ranged from 4 - 64 years with a median of 29.50 years. Motor vehicular road traffic accident (RTA) was the most common (46.43%) aetiology. Excision and anastomosis was the most common type of urethroplasty performed (71.43%) and the most common complication was stricture recurrence (32.14%).

Conclusion

Though urethroplasty techniques have become more refined, accessibility of care continues to hamper treatment in Sub-Saharan Africa due to socioeconomic issues.

Significance of inflammatory biomarkers and urethral histology in patients with urethral stricture disease in relation to treatment outcome—a single centre prospective study in the north-eastern part of India

Background

Inflammation plays a very important role in defining the urethral stricture. Inflammatory biomarkers may play an important role in predicting the underlying pathophysiology as well as outcome of surgery. Histology of urethral strictures along with histology of urethra proximal and distal to stricture segment may have a role in predicting the outcome of the surgery. The literature discussing this aspect is rare; thus, this novel study aimed to find out the role of inflammatory biomarkers and urethral histology in predicting the outcome of surgery in urethral stricture disease.

Methods

This prospective study had 105 patients with age more than 15 years with urethral stricture. Baseline characteristics, routine blood tests including inflammatory blood markers (CRP, ESR, HbA1C, fasting insulin, serum ferritin, etc.) were recorded. They underwent various types of surgery, and first biopsy was taken from stricture segment and second biopsy from proximal to stricture segment and third biopsy from distal to stricture segment and evaluated for the presence of features of lichen sclerosus and inflammation. Primary endpoint was to diagnose the role of inflammatory biomarkers and histology of stricture in stricture recurrence.

Results

Their mean age was 43.3 ± 13.46 years. Mean CRP of 11.54 ± 3.64 in patients with failure and 9.59 ± 2.77 in patients with successful outcome (p 0.025). Other inflammatory biomarkers like HbA1C, fasting insulin, ESR, serum ferritin, NLR had no significant correlation with the outcome. The presence of features of lichen sclerosus like hyperkeratosis and severe inflammation in stricture segment predicted higher likelihood of failure. Histology of proximal and distal segment of urethral stricture had no significant relationship in predicting outcome. Staged urethroplasty with buccal mucosal graft outperformed single-stage urethroplasty in biopsy-proven LS strictures.

Conclusions

The present study found a negative impact of increased CRP and the presence of features of lichen sclerosus in urethral histology with the outcome of urethral stricture disease. Thus, our study confirms that inflammatory biomarkers (CRP) and histology of stricture segment play a significant role predicting the outcome of surgery.