A Review of the epidemiology and management of urethral stricture disease in Sub-Saharan Africa

Irekpita, Eshiobo; Ernest, Udefiagbon

doi:10.4103/cmi.cmi_37_19

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…The prevalence of urethral stricture disease (USD) in SSA is difficult to define due to the limited availability of locallycollected data [4,5] and is, perhaps, skewed by restricted data from centres supported by international bodies such as the WHO [6], or academic centres from high-income countries (HICs) [5,7]. However, USD's importance as a clinical presentation demanding treatment makes it an omnipresent challenge to specialist surgeons in SSA [8,9], as well as other resource-poor healthcare environments globally [5]. Whilst HICs manage most strictures, at least initially, with less invasive measures such as urethral dilatation (UD) or endoscopic techniques such as hot or cold knife direct visual internal urethrotomy (DVIU), with or without postoperative clean intermittent self-dilatation (CISD) [10][11][12], these options, apart from UD, are not always available to specialists in LMICs [5,8].…”

Section: Introductionmentioning

confidence: 99%

“…However, USD's importance as a clinical presentation demanding treatment makes it an omnipresent challenge to specialist surgeons in SSA [8,9], as well as other resource-poor healthcare environments globally [5]. Whilst HICs manage most strictures, at least initially, with less invasive measures such as urethral dilatation (UD) or endoscopic techniques such as hot or cold knife direct visual internal urethrotomy (DVIU), with or without postoperative clean intermittent self-dilatation (CISD) [10][11][12], these options, apart from UD, are not always available to specialists in LMICs [5,8]. Additionally, the aetiology of strictures, and their complexity, is often fundamentally different to that seen in many HICs [5,13].…”

Section: Introductionmentioning

confidence: 99%

“…Debas et al [21], in their expansive tome on emergency surgery in LMICs, make scant reference to urological problems, despite BOO being responsible for significant morbidity for at least a billion people globally [22]. BOO results in great hardship in resource-poor settings, with a substantial negative impact on the quality of life and productivity of the affected population [23]; it is also a major reason for referral to the limited number of specialist urologists available [1,6,8,13,24].…”

Section: Introductionmentioning

confidence: 99%

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Male urethral stricture disease: why management guidelines are challenging in low‐income countries

et al. 2022

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Urethral stricture disease (USD) is one of the commonest urological pathologies in adult men in low-or low-middleincome countries, providing a significant work burden for the small number of specialist surgeons who are able to provide appropriate treatment. The underlying causes of anterior urethral stricture relate to urethral fibrosis from sexually transmitted infection, with posterior urethral disruption secondary to pelvic trauma being an equally common cause of USD in many countries in sub-Saharan Africa. Anterior urethral strictures are often long, and multifocal, and bulboprostatic disruptions are usually due to relatively low-velocity pelvic trauma. The management options available in resourcepoor settings are often severely limited by the individual's ability to pay for care, the availability of a specialist surgeon and, importantly, a shortage of functioning endoscopic equipment for less-invasive treatments. Consequently, reconstructive surgery is often regarded by the patient, and surgeon, as the most cost-effective and, therefore, primary means of treating a urethral stricture once urethral dilatation has failed. Regional anaesthetic techniques have limited the adoption of free-graft augmentation as an alternative to pedicled flaps of locally available skin for reconstruction, whilst an inability to provide tension-free bulbo-prostatic anastomoses has negatively impacted the outcome from the treatment of pelvic fracture disruption injuries in much of sub-Saharan Africa. However, Urolink has found that local surgeons can be taught sustainable skills required for successful complex urethroplasty when supported by longitudinal mentorship in the management of difficult clinical issues. Evidence-based practice is known to improve the standard of care in specific conditions in high-income countries, including the management of male USD. However, guidelines developed in highincome countries are not necessarily appropriate for stricture management in less well-resourced healthcare environments but could be adapted to help improve the delivery of stricture care for men in low-or low-middle income countries.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Male urethral stricture disease: why management guidelines are challenging in low‐income countries

et al. 2022

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Evaluation of the Quality of Micturition in Patients Who Underwent Anastomotic Urethroplasty at the Yaounde Central Hospital, Cameroon

Mbassi,

Mbouche,

Mekeme

et al. 2024

OJU

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Introduction: Radiological investigation which is the gold standard to perform following anastomotic urethroplasty in order to evaluate the quality of micturition is costly. In our context, due to financial limitations, reconstructive urologists prefer to use the uroflowmetry in order to assess the micturition post-surgery. Therefore, the objective of the study was to assess the quality of micturition using the uroflowmetry after anastomotic urethroplasty. Methodology: We conducted an 11-year retrospective review (1 st January 2006-31 st December 2017) and a cross-sectional descriptive observational study for a period of 8 months (November 2017-June 2018) at the Urology and Andrology Department of the Yaounde Central Hospital (YCH) of patients who were diagnosed with urethral stenosis and underwent an anastomotic urethroplasty at the YCH. We excluded patients who had incomplete files, patients lost to follow-up and did not do pre-operative uroflowmetry. Quality of micturition was evaluated using a uroflowmetry. Data was analyzed using EPI info 7.0. Parametric variables were reported as means and standard deviations and percentages and counts were used to report categorical variables. Results: We had a sample of 60 patients. The mean age was 42 ± 5 years with extremes ranging from 20 to 76 years. Twenty-seven (27) patients, or 45%, had no post-operative complications, and those who did had a urinary tract infection

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Management and Outcome of Urethral Strictures at Two Tertiary Health Facilities in Cameroon

Mokake,

Eyongeta,

Ekani

et al. 2024

OJU

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A Review of the epidemiology and management of urethral stricture disease in Sub-Saharan Africa

Cited by 3 publications

References 3 publications

Male urethral stricture disease: why management guidelines are challenging in low‐income countries

Male urethral stricture disease: why management guidelines are challenging in low‐income countries

Evaluation of the Quality of Micturition in Patients Who Underwent Anastomotic Urethroplasty at the Yaounde Central Hospital, Cameroon

Management and Outcome of Urethral Strictures at Two Tertiary Health Facilities in Cameroon

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