The Clinical Patterns of Presenting Signs and Symptoms of Anterior Urethral Stricture Disease at the Kenyatta National Hospital (KNH)

Abstract

Background: Globally, urethral stricture disease (USD) accounts for 0.6% of older patients and is a disease with associated financial toxicity and multiple comorbidities. This condition dramatically influences patients' quality of life and may require emergency intervention. Most studies show that about 47% of USD presenting signs and symptoms are not captured in most of the assessing tools including American Urological Symptom Index (AUA-SI) and International Prostate Symptoms Score (IPSS). Objective: To determine the clinical patterns of presenting signs and symptoms of Anterior Urethral Stricture Disease (AUSD) at the KNH, Nairobi County Methodology: This was a 5-Year (2017-2021) retrospective study of adult (Female/Male) patients diagnosed and managed for AUSD at the Kenyatta National Hospital (KNH). Sample Size: A sample of 385 was calculated via the Cochrane formula (1963) and all the files were obtained and included in data analysis representing a 100% acquisition rate. Data Analysis: Data was collected using a standardised questionnaire, cleaned, and analysed using STATA 13.0 to determine the frequency of signs and symptoms. aetiologies, length and sites of urethral stricture. Binary logistic regression was performed to investigate the association between the chief complaints and stricture aetiology, stricture site and stricture length. The odds ratio was calculated to show the direction and strength of the association. The level of significance was considered at p<0.05. Results: The median age was 46 (IQR: 33 – 62) years with 41.8% (n =161) of patients aged ≥50 years while the mean age was 46.8 with standard deviation (SD) of 18.12. Majority, 68.6% (n =264), were married, 65% (n =250) were unemployed while 56.9% (n =219) were urban dwellers. Of the 18 symptoms reported by patients, the commonly occurring chief complaints were straining 24.7% (n =95), urinary retention 22.7% (n =87) and weak stream, 10.2% (n =39). The common stricture aetiology was trauma, 35.8% (n =138) and followed by post infection caused stricture 23.6% (n =91). Bulbar strictures were the commonest, accounting for 78 %. A stricture length averaging 1-2 cm (55.8%) was the most predominant. Infectious, inflammatory, traumatic and iatrogenic strictures presented with straining/ difficulty passing urine at 18.7%, 26.7%, 26.1% and 29.6% respectively. Patients with traumatic stricture were 3.3 times more likely to present with Urinary retention (OR=3.33. 95CI: 2.04- 5.44, P<0.001) while idiopathic stricture had 2 times the likelihood of obstructive/voiding symptoms (OR=1.98, 95%CI:1.20 – 3.25, p=0.008). Stricture length greater than 2 cm was two times more likely to present with pain-related signs/symptoms (OR=2.01, 95% CI: 1.10-3.74, P= 0.024). Penile stricture has 1.8 times more likelihood to present with obstructive signs/symptoms (OR=1.84, 95%CI: 1.20-2.81, P= 0.005) Conclusion: It is a disease of protean clinical manifestation. From the forgoing study, conspicuous amongst these were straining, urinary retention and weak stream. Bulbar urethral stricture presented with straining and urinary retention. Traumatic strictures were more likely to present with UR while idiopathic strictures presented with obstructive or voiding symptoms. The greater the length of the stricture (>2 cm), the greater the obstruction and high likelihood of presenting with pain related symptoms. It is imperative that meticulous documentations of presenting signs and symptoms be done to optimize treatment outcome.