Elsevier

Urology

Volume 79, Issue 5, May 2012, Pages 1163-1167
Urology

Reconstructive Urology
The Clinical Spectrum of the Presenting Signs and Symptoms of Anterior Urethral Stricture: Detailed Analysis of a Single Institutional Cohort

https://doi.org/10.1016/j.urology.2012.01.044Get rights and content

Objective

To accurately delineate the presentation of anterior urethral stricture in an economically developed patient cohort. It is widely assumed that patients with urethral stricture typically present with lower urinary tract symptoms (LUTS). There is a paucity of data examining this assumption. With no uniformly accepted clinical definition or measure of treatment success, a clear clinical description of urethral stricture is important.

Methods

Retrospective detailed analysis was performed on 611 patients presenting with anterior urethral stricture from July 2004 to June 2010. Both the presenting complaint and associated signs and symptoms were classified according to one of 10 clinical categories.

Results

The most common presenting complaint was LUTS typical of those found on the American Urological Association-Symptom Score (54.3%) and another 23.4% of patients presented initially with acute urinary retention (AUR). Symptoms other than LUTS or urinary retention accounted for 22.3% of presenting complaints. In addition, 22.9% of patients had genitourinary pain, 50.7% of patients required emergent urologic treatment, and 7.4% of patients presented with renal insufficiency or urethral abscess/necrotizing fasciitis directly related to urethral stricture.

Conclusion

Although many patients with urethral stricture present initially with LUTS or AUR, almost one quarter of patients have a different presenting complaint. Defining successful treatment of anterior urethral stricture should include more than improvement in LUTS or absence of urinary retention. Urethral stricture is not just a “quality of life” condition because >50% of patients require emergent treatment and 7.4% have a life-threatening condition directly related to the stricture.

Section snippets

Material and Methods

Institutional ethics board approval was obtained for this retrospective review. The complete health records of patients presenting for evaluation and management of anterior urethral stricture over a 6-year period were analyzed. All pertinent institutional data, referring physician, and office records were abstracted into a database and screened by 2 separate individuals to identify potential issues regarding data inconsistencies or integrity. This study cohort was composed of patients with true

Results

Six-hundred eleven patients met the study criteria with all presenting, and associated signs and symptoms information available for analysis All patients underwent cystoscopy to confirm the clinical diagnosis of urethral stricture, and 591 patients (96.5%) underwent retrograde urethrography as a further staging modality. Mean patient age was 48.9 years (range 6-91). Stricture length was an average of 5.7 cm as staged by retrograde urethrography. Stricture etiology was most commonly idiopathic

Comment

It is assumed by many that “most patients (with urethral stricture) present with progressive symptoms of lower urinary tract obstruction.”2 Despite a paucity of data examining this assumption, it has widely impacted the clinical practice of urethral stricture, including evaluation, treatment, and follow-up.4 Over the last 20 years, care of the patient with urethral stricture has evolved from a mostly endoscopic approach to one in which open urethroplasty can successfully achieve long-term

Conclusions

Although many patients with urethral stricture present with LUTS or AUR, almost one-quarter of patients have a different presenting complaint. Defining a successful outcome after treatment for anterior urethral stricture should include more than improvement in LUTS or absence of urinary retention. In addition, urethral stricture is not solely a “quality of life” condition, because >50% of patients require emergent urologic treatment and 7.4% have a life-threatening condition directly related to

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