Stricture of the urethra: the disease as seen at the Kenyatta National Hospital over a one year period, 1982 - 1983

Abstract

A prospective study of seventy seven patients with urethral strictures treated at the Kenyatta National Hospital over a period of twelve months (1982-1983) was done. The age, tribal, and aetiologi cal incidencies were investigated. Various aspects of the clinical presentation, investigation and treatment were also looked at.'post-inflammatory strictures were significantly more than post-traumatic and iatrogenic strictures. However, post-prostatectomystrictures were not included with the later. The lapse period following post-inflammatory strictures was abouh 5Years,on,the,average. Omo-Dare quotes 18 years for a Nigerian study done two decades ago for post-gonococcal strictures. It was not possible to determine the initial cause of urethritis in this study due to the fact that most patients had no' cultures for the organisms done at the time of infection. Some were treated at dispensaries and previous medical records were unobtainable Data on tribal incidence could not be critically analysed without bais due to the uneven distribution of the tribes around the Nairobi area. Others live a few kilometers away and others hundreds of kilometers. Half of the urine cultures done were negative. The rest grew gram negative organisms, mainly E.coli. No gonococci were isolated. B.U.N. was elevated above normal in about one third of the patients intravenous pyelograms were normal in four-fifths of the patients investigated. Micturating urethrogral'%done in eleven patients showed the majority of strictures to be in the posterior urethra. Seventy-three percent of the patients were managed with intermittent dilatations with good results. Urethroplasty was done in 23% and urethrotomy in 4% of the patients - urethroplasty was offered more to the younger age group. The need for proper health education to the public about this disease and its causes is emphasized. Suggestions for better management of. these patients are forwarded. Special stress on the benefits of urethrotomy under vision for suitable patients is made. A critical review of the various types of urethroplasty is also presented.