Efficacy of revision urethroplasty in the treatment of recurrent urethral strictures at a tertiary hospital (Kenyatta National Hospital–KNH), in Nairobi Kenya: 2015-2018

Abstract

Background: Urethral strictures cause malfunction of the urethra. Urethroplasty is a cost-effective treatment option. Its success rate is greater than 90% where excision and primary anastomosis(EPA)is performed and 80-85% following substitution urethroplasty. Definitive treatment for recurrent urethral strictures after urethroplasty is not defined. Repeat urethroplasty is a viable option with unknown efficacy.Method: Retrospective analysis of patients who underwent revision urethroplasty for unsuccessful urethroplasty at KNH from 2015 to 2018 was performed. Patients’ age, demographic data, stricture length, location, aetiology, comorbidities and type of urethroplasty was evaluated from records with complete data. Male patients aged 13 to 80years were evaluated. Comparison of urethroplasty outcome between two patient cohorts was made: Fresh urethroplasty patients versus failed urethroplasty who underwent revision so as to determine efficacy of the later. Principal outcome measure was urethral patency, while Subsidiary outcome measures were associated complications. Outcomes were compared using statistical package SPSS version 23.0.Result: 235 patients who met inclusion criteria underwent urethroplasty, 71.5% (n=168) had a successful outcome, while28.5% (n=67) failed and were subjected to revision urethroplasty. Another 58% were successful upon revision but experienced significant morbidity. Majority of urethral strictures were bulbomembranous. Trauma was the leading cause of urethral strictures followed by idiopathic strictures. EPA was the commonest surgery while Tissue transfer featured prominently in revision urethroplasty. A significant correlation was evident between stricture length, prior surgery, and procedure choice and urethroplasty outcome.Conclusion: Revision urethroplasty is feasible after failed urethroplasty but less efficacious. Stricture length, number of prior surgeries and procedure choice affected outcome.EPA and Tissue Transfer techniques are essential surgical armamentarium in revision setting.