Short Term Effects of Direct Vision Internal Urethrotomy on Uroflowmetry Parameters in Male Anterior Urethral Stricture Treatment in Port Harcourt

Abstract

Background: Anterior male urethral stricture is a common pathology which presents to the urologist and cause a lot of morbidity to the patient. Different options of treatment based on different criteria are available. Direct vision internal urethrotomy(DVIU) is a minimal invasive technique applicable in men with short segment urethral strictures with good outcomes. However the length of sustainability of initial success has been out to question Objectives: To determine the short term effects of DVIU procedure on uroflowmetry parameters in male anterior urethral strictures treatment in Port Harcourt. Materials and Methods: This is a hospital based prospective non blinded study of patients with short segment anterior urethral stricture ≤20mm. Ethical approval and informed consent were obtained. All patients included in the study had a retrograde urethrogram and a micturating cystourethrogram. They were evaluated using uroflowmetry before, immediate post operatively and six months after DVIU. Data were entered into Microsoft Excel 2010 and analyzed with Data Analysis Tool Pak (version 3.0). Results: Twenty six patients were studied. The age group 30 to 39 years had the highest frequency with 11(42.3% of respondents). Bulbar urethral strictures accounted for 76.9% of cases. Inflammatory causes accounted for 50.0% of cases. The mean maximum flow rate before intervention was 10.1ml/sec. There was a marked increase in the maximum flow rate and average flow rate of 20.1ml/sec and 8.03ml/sec respectively in the immediate postoperative period and this was found to be statistically significant. There was however a significant decline in both maximum flow rate and average flow rate six months after intervention. The reoperation rate post DVIU following recurrence was 7.6%. Reconstructive urethroplasty was used in these. There is a negative Pearson’s correlation with a 0.16ml/sec reduction in maximum flow rate with every 1mm increase in stricture length. Conclusion: DVIU as a treatment for short segment anterior urethral stricture causes marked improvement in uroflowmetry parameters in the immediate postoperative period. There is, however, decline in success rates in the long-term period. Increasing length of stricture is associated with reduction in maximum flow rate.