[Male urethral stenosis: review of complications]

Abstract

Objectives: To evaluate a historical series of urethral stenosis retrospectively. To study the urinary, genital and systemic complications. To study risk factors for the development of such complications and, based on them, identify groups of patients more susceptible to complications with the aim to establish prophylactic, therapeutic or follow-up actions.

Methods: We studied 175 male patients with urethral stenosis, which constitute the historical series of male urethral stenosis treated in the Hospital General Universitario in Alicante from 1977 to 1987 (11 years). Statistical treatment: clinical protocol for data collection. Codification of variables. Descriptive statistics for all variables. Percentage description of qualitative variables. Data processing by the basic SPSS + statistical software and the Harvard Graphics graphical software ran in an IBM PS/2 computer. The level of statistical significance for comparisons between variables was established in p < 0.05.

Results: 155/175 patients presented complications (88.57%). The number of complications overall was 795. Complication sites in order of frequency were: 628 (78.99%) urinary tract, 111 (13.96%) genital system, 44 (5.53%) systemic and 12 (1.50%) abdominal wall hernias. The most frequent complications were: acute urinary retention 100 patients, bladder obstructive uropathy 84, urinary tract infection 63, ejaculation disorders 50, stenosis recurrence 47, and 30 with various degrees of renal failure. Most complications were reversible after resolution of the stenosis, although 3 patients had non reversible deterioration of their renal function and 4 unilateral postobstructive renal atrophy 3 patients died as a consequence of such complications (two cases of septicemia and one postoperative pulmonary embolism. Prophylaxis is the best treatment for these complications, eradicating urinary tract infection if present, and treating stenosis itself. Nevertheless, the treatment of complications required 132 medical treatments, 16 suprapubic bladder punctions, 94 surgical treatments, 5 extracorporeal shock wave lithotripsies, 2 mechanical lithotripsies, and 1 hemodialysis in a patient with end stage renal disease (single kidney with ureteritis secondary to tuberculosis). Risk factors for the development of complications are among others: age > 70 years (retired), history of sexually transmitted diseases, urinary tract infection, previous urethral surgery for recurrent stenosis, and post void residual urine.

Conclusions: Complications of urethral stenosis are very frequent in this series. Currently, in comparison with past times, these complications can be prevented, since its diagnostic is very simple by ultrasound. Many of these complications are reversible if obstruction and infection are corrected. Based on these results we have identified several groups of patients with higher risk of complications. Global studies of this issue are necessary, both national and international.