Urethral Stricture Etiology Revisited: An Indian Scenario

Abstract

Objectives: Urethral stricture disease remains a common cause of morbidity among men. Many questions about the etiology of urethral stricture disease remains unanswered till now. This study was done in a tertiary care center along with a review of the literature to evaluate the etiology of urethral strictures and to determine the factors that may influence possible preventive or curative strategies. Methods: This was a retrospective and prospective study of 404 patients with urethral strictures. The case records of all these cases diagnosed as urethral stricture were analyzed to determine the possible cause of the stricture, demographic profiles, and clinical presentation. Data were entered both prospectively by a careful patient questioning and retrospectively from a detailed chart review. A subanalysis of the stricture etiology of patients aged less than 40 years vs patients aged 40 or more was done. Statistical analysis with the Fisher's exact test was done, and a P value < 0.05 was considered statistically significant. results: The mean age of presentation was 41.2 years (range: 3 to 81 years). Overall, the iatrogenic cause was the most common (40.6%), but stricture etiology varied with age and the stricture site. conclusions: The etiology of urethral strictures is not uniform across the world. The iatrogenic and idiopathic strictures are surprisingly common. Avoiding unnecessary urethral catheterization and repeated urethral instrumentation can reduce iatrogenic strictures.

Narrowing in on urethral strictures

“…Currently, lichen sclerosus is the most common identifiable cause of penile strictures in young and middle-aged men. 8 It causes atrophic fibrosis and is thought to be autoimmune in nature, although an infective aetiology has also been proposed. Typically, lichen sclerosus begins as an itchy white patch on the inner aspect of the foreskin or glans (Figure 2).…”

The Urological Society of India Guidelines for the management of urethral stricture (Executive Summary)

“…Urethral catheterization was a more frequent cause than transurethral surgery in this population. [ 2 ] A study comparing characteristics of strictures in men undergoing urethroplasty at leading centers in India and the West suggested that trauma-related strictures were much more common in India (36% vs. 15.8%), whereas the iatrogenic were lesser (16% vs. 35%). The incidence of Lichen Sclerosus (LS)-associated strictures were three times as compared to the western data (21.5% vs. 6.9%).…”