Etiology of Posterior Urethral Strictures: Analysis of 116 Cases

Year 2020, Volume: 53 Issue: 2, 76 - 80, 31.08.2020

Cem Nedim Yücetürk Buğra Bilge Keseroğlu

https://doi.org/10.20492/aeahtd.748289

Abstract

Purpose: In this study our aim was to investigate the current etiology of posterior urethral stricture disease in our department and to observe if there have been any differences in the major causes of urethral strictures.
Patients and Methods: We analysed 116 male patients between March 2009 and September 2019 to evaluate the etiology of posterior urethral strictures. All patients had been assesed preoperatively,including detailed medical history,physical examination,retrograde urethrogram and uroflowmetry. We examined all patients in terms of age, stricture site,the most probable cause of the stricture and stricture length. We classified the location of posterior stricture into three anatomic parts: membranous urethra,prostatic urethra and bladder neck and stricture etiologies were subcategorized into idiopathic,inflammatory,iatrogenic and traumatic.
Results: The most common site of the strictures was the membranous urethra (67 patients, 57.8%) followed by the prostatic urethra ( 27 patients, 23.3%) and bladder neck (22 patients, 18.9%). The two main overall posterior urethral stricture causes were iatrogenic (79 patients,68.1%) and traumatic (24 patients,20.7%).The less common causes were idiopathic (11 patients,9.5%) and urethritis(2 patients,1.7%). Of the patients in iatrogenic group, TUR-P and TUR-BT were the most common etiologic factors. ( 42 patients,36.2%) All urethral strictures were short(<2 cm) and treated with endourological surgery.( Optical İnternal Urethrotomy and urethral dilation)
Conclusion: In our instution, especially iatrogenic causes were the most seen etiologic factor of posterior urethral strictures.These findings suggested us to be more careful during the endoscopic procedure , to use suitable calibered instrumentation and avoid unnecessary urethral interventions.

Keywords

Etiology, iatrogenic disease, transurethral prostate resection, trauma

References

• 1. Lumen N, Hoebeke P, Willemsen P, De Troyer B, Pieters R, Oosterlinck W: Etiology of urethral stricture disease in the 21st century. J Urol. 2009; 182: 983–87. 2. De Sy WA, Oosterlinck W, Verbaeys A. Le traitement du retrecissement de I’ uretre masculine. Acta Urol Belg.1981; 49:101–2 3. Fenton AS, Morey AF, Aviles R et al: Anterior urethral strictures: etiology and characteristics. Urology 2005; 65: 1055-58. 4. Palminteri E, Berdondini E, Verze P, De Nunzio C, Vitarelli A, Carmignani L: Contemporary urethral stricture characteristics in the developed world. Urology 2013; 81: 191–96. 5. Mathur R, Aggarwal G, Satsangi B, Khan F, Odiya S: Comprehensive analysis of etiology on the prognosis of urethral strictures. Int Braz J Urol. 2011; 37: 362–69. 6. Xu YM , Song LJ, Wang KJ et al. Changing Trends in the Causes and Management of Male Urethral Stricture Disease in China: An Observational Descriptive Study From 13 Centres. BJU Int. 2015; 116(6):938-44. 7. Barbagli G, Guazzoni G, Lazzeri M: One-stage bulbar urethroplasty: retrospective analysis of the results in 375 patients. Eur Urol. 2008; 53: 828-33. 8. Santucci RA, Joyce GF, Wise M. Male urethral stricture disease. J Urol.2007; 177: 1667–74. 9. Santucci RA, Mario LA, McAninch JW. Anastomotic urethroplasty for bulbar urethral stricture: analysis of 168 patients. J Urol. 2002; 167: 1715–19. 10. Astolfi RH , Lebani BR, Krebs RK et al. Specific Characteristics of Urethral Strictures in a Developing Country (Brazil).World J Urol. 2019; 37(4):661-66. 11. Rassweiler J, Teber D, Kuntz R, Hofmann R.Complications of transurethral resection of the prostate (TURP) – incidence, management, and prevention. Eur Urol. 2006; 50: 969–79. 12. Elliott SP, Meng MV, Elkin EP, McAninch JW, Duchane J, Carroll PR, CaPSURE Investigators : Incidence of urethral stricture after primary treatment for prostate cancer:data from CaPSURE. J Urol. 2007;178: 529-34. 13. Tascı AI, Ilbey YO, Tugcu V, Cicekler O, Cevik C, Zoroglu F: Transurethral resection of the prostate with monopolar resectoscope: single- surgeon experience and long-term results of after 3589 procedures. Urology. 2011; 78:1151–55. 14. Kashefi C, Messer K, Barden R, Sexton C, Parsons JK: Incidence and prevention of iatrogenic urethral injuries. J Urol. 2008; 179: 2254–57. 15. Depasquale I, Park AJ, Bracka A. The treatment of balanitis xerotica obliterans. BJU Int. 2000; 86(4):459–65. 16. Baskin LS, McAninch JW. Childhood urethral injuries: perspectives on outcome and treatment. Br J Urol. 1993; 72(2):241–46. 17. Stein DM, Thum DJ, Barbagli G et al . A geographic analysis of male urethral stricture aetiology and location. BJU Int. 2013; 112(6):830–34. 18. Fall B, Sow Y, Mansouri I et al. Etiology and current clinical characteristics of male urethral stricture disease: experience from a public teaching hospital in Senegal. Int Urol Nephrol. 2011; 43(4):969–74. 19. Alwaal A, Blaschko SD, McAninch JW, Breyer BN. Epidemiology of urethral strictures. Transl Androl Urol. 2014; 3(2):209-13. 20. Guo FF, Lu H, Wang GJ et al. Transurethral 2-microm laser in thetreatment of urethral stricture. World J Urol. 2010; 28: 173–5. 21. Mathur R, Aggarwal G, Satsangi B, Khan F, Odiya S. Comprehensive analysis of etiology on the prognosis of urethral strictures. Int Braz J Urol. 2011; 37: 362–9. 22. Bullock TL, Brandes SB. Adult anterior urethral strictures: a nationalpractice patterns survey of board certified urologists in the United States. J Urol. 2007; 177: 685–90.