The endoscopic treatment of urethral strictures in Mekelle, Ethiopia

This is to indicate that direct vision cold knife internal urethrotormy (DVU) was found simple, quick and cost effective mode of operation in urethral strictures in maintaining acceptable voiding patterns.

This was a retrospective study of patients seen at the surgical referral clinic from Nov. 1, 2004 - Jun. 30, 2006 in Mekelle hospital with symptoms suggestive of urethral strictures. All patients included in the study were subjected to retrograde (and/or antegrade where indicated) urethrography. Adequate records have been maintained in the hospital on patients undergoing DVU. The patient's name, age and urinary symptoms were recorded. The location, length and caliber of the strictures were estimated and recorded from urethrogram and at urethroscopy during the procedure.

There were 57 patients underwent direct vision cold knife (internal) urethrotomy (DVU), all of them in Mekelle hospital. The ages ranged from 14-82 years (mean 47.7 years) and the median age was 43 years. The duration of symptoms ranged from 3 months to 15 years (mean 23 months). Most patients (82.4%) had strictures followed infections (Table 1). Others were due to trauma (10.5%), urethral catheter, (8.7%) and TURP (1.1%). About 68.4% of the strictures were in the bulbar urethra and other sites were in the penile (19.3%), bulbo penile (7.0%) and in the membranous (5.3%) part of the urethra. The length of the strictures ranged from 2 mm to 20 mm (mean 16 mm) and had an estimated diameter from 1-2 mm. Direct vision cold knife urethrotomy was successfully done in 50 patients accounting for (87.2%) after one adequate urethrotomy. Seven patients had failed DVU after one adequate attempt accounting for (2.3%). Of those successful direct vision internal urethrotomies, three had later come with severe recurrent strictures accounting for (6.0%) and had undergone urethroplasty.

Direct vision cold knife internal urethrotomy is a simple, cost effective and versatile method of treatment in urethral strictures which is attractive where resources are scarce.