Experiencia en el manejo de la estrechez uretral en un centro de tercer nivel en Colombia

Abstract

ObjectiveTo describe the sociodemographic and clinical characteristics, as well as the treatments performed, of patients with urethral stricture in a tertiary level hospital. MethodsA descriptive study was performed based on manual search of medical records of patients with urethral stricture, who were diagnosed, treated, and followed-up from June 2012 to June 2014. A description is presented of the demographic characteristics of patients, their risk factors, comorbidities, and clinical conditions, as well as re-interventions. The perioperative complications were reported according to the Clavien–Dindo system. A descriptive analysis was performed using STATA v. 14. ResultsA total of 35 cases were identified. The median of age was 58 years old. Eighteen patients (51%) had a history of urological instrumentation as a cause of urethral stricture. The most common anatomical site of the stricture was the bulbar segment, the median length of the narrow area of three centimetres. Diagnostic methods used were retrograde urethrogram, cystoscopy, and cystography (97%). As regards treatment, minimally invasive procedures were performed on 14 (40%) patients. Urethral dilation was performed in 40% of patients, with internal urethrotomy in 8 (23%) patients. End to end urethroplasty was performed in 20 patients, with posterior graft in 10 (29%) patients and with ventral graft in 4 (11%) patients. There was one minor complication (grade I) in one patient. There was a median urethral catheter use of 24 days. Patients were followed-up using a symptoms scale (100% of cases). Urethral stricture re-appeared in 16 patients, with median recurrence of 48 days. Recurrence was treated with internal urethrotomy in 7 (20%) patients. ConclusionUrethral reconstructive surgery is the procedure of choice for management of the condition, with adequate effectiveness, low incidence of recurrence, and minor complications. Performing minimally invasive procedures, such as internal urethrotomy and urethral dilation prior to reconstructive surgery, is a major risk factor for recurrences.