The short term success of direct vision internal urethrotomy (dviu) in the management of anterior male urethral strictures

Abstract

Background: The male urethral stricture disease is a common urethral tract disease that occurs in all age groups. Direct vision internal urethrotomy (DVIU) is a common intervention procedure for anterior male urethral strictures less than two centimetres in length. The outcome studies on DVIU procedure have shown a wide range of success rates. The purpose of this study was to evaluate the short term success of DVIU in treating male anterior urethral strictures in patients presenting to Kenyatta National Hospital (KNH). Objective: To determine the short term uroflowmetry outcomes after the DVIU procedure in male anterior urethral strictures treatment at KNH using uroflowmetry measurements. Study design: This was a prospective descriptive study. Study Setting: The general surgical wards, the minor theatre in clinic 24 and the urology outpatient clinic in Kenyatta National Hospital, in Nairobi, Kenya. Patients and methods: Sixty six consenting male patients above the age of eighteen years old presenting to KNH with anterior urethral strictures less than two centimetres in length as per their RUG/MCU films were studied. The following data was obtained: maximum flow rate (Q max), average flow rate per second, voided volume and a voiding curve from a urodyne100 uroflowmetry machine stationed at the minor theatre in clinic 24. These uroflowmetry results were obtained in the pre operative period, the immediate post operative period and at twelve weeks post operation during the follow up of the patients. Results: A total of 66 male patients with anterior urethral strictures were included in the study. The mean preoperative maximum flow rate was 7.2 ± 5.2. The Q max rate increased significantly by an average of 6.1 mls/sec (95% CI 3.9-8.2) in the immediate post intervention period (p < 0.001) and by 3.1mls (95% CI 2.3-3.8) at 12 weeks xii follow up post operation (p < 0.001). In the pre operative period 63 patients (95.4%) had flat voiding curves. The percentage of patients with flat voiding curves reduced to 57.6% in the immediate post operation period. At twelve weeks post intervention 63.4% of patients had flat voiding curves. A total of five patients had a re-operation during the study period. The reoperation rate for the urethral strictures was 7.6%. Conclusion: The maximum flow rates achieved during DVIU procedure has a significant decline by twelve weeks post operation .The DVIU procedure may be used as a palliative procedure while awaiting a definitive procedure for male anterior urethral strictures less than two centimetres in length.