Evaluation of the etiological profile, age and findings in retrograde and voiding urethrocystography of men with urethral stricture

Abstract

This study aims to establish a profile of the urethral stricture disease in the studied population, in addition to evaluating the correlation between the etiology of urethral stricture, age and findings evidenced in the retrograde and voiding urethrocystography (RVUC) examination. This observational study was conducted at a single institution and included 135 men with urethral stricture. Patient's age and the etiology of stricture were determined. RVUC findings such as length, number, location, and degree of urethral lumen obstruction of urethral stricture, as well as other associated pathological urological findings, were also analyzed. The correlation between demographic parameters, including age and etiology, and RVUC findings was then statistically analyzed. Median age of the patients was 64 years (range: 18-89 years). The most frequent etiologies were iatrogenic (51.9%), idiopathic (20.0%), inflammatory (15.6%) and external traumatic (12.6%). The subgroup of patients over 45 years of age had higher percentages of urethral stricture regardless of the etiology. In the comparative analysis between the four etiology categories, age group and location were the two variables with a statistically significant association (p = 0.001 and < 0.001, respectively). The penile urethral segment represented almost half of the cases of stricture of inflammatory etiology (47.6%). In the membranous urethral segment, almost all cases of stricture were of iatrogenic etiology, representing 24.3% of all cases of iatrogenic etiology in the study. Comparative statistical analysis between the traumatic and non-traumatic etiology categories found that location and length were the only variables with a statistically significant association (p < 0.001 and = 0.005, respectively). In the penile urethral segment, stricture of non-traumatic etiology was the most frequent (33.3% versus 11.5%). In this study, strictures were only of traumatic etiology in the membranous (20.7%) and prostatic (6.9%) urethral segments. Strictures of non-traumatic etiology were the longest. In another supplementary analysis, a statistically significant association was evidenced between age group and the specific cause of urethral stricture (p < 0.001). Prostatectomy was the main specific cause of urethral stricture considering all age groups, representing 20.7% of all cases in the study and 25.2% of patients aged over 45 years. The idiopathic and urethral catheterization were more frequent causes proportionally in the subgroup of patients aged 45 years or less than in the subgroup aged over 45 years (41.7% versus 15.3%, 29.2% versus 6.3%, respectively). A more severe disease profile of urethral stricture was evidenced, with 83% of cases causing obstruction in more than 2/3 of the urethral lumen. In our study, there was a significant statistical association between the etiology and patient's age, and also between the etiology and stricture's location and length as demonstrated by the RVUC exam.

Keywords: Age groups; Cystography; Diagnosis; Diagnostic imaging; Etiology; Urethral stricture; Urethroplasty.