Resume Objectif Evaluer la prise en charge des patients atteints de stenose post-traumatique de l’uretre dans notre institution. Materiel et Methodes De janvier 1988 a aout 2005, 180 interventions chirurgicales ont ete realisees chez 105 patients pour traitement de lesions post-traumatiques de l’uretre bulbo-membraneux apres fracture du basin (79%) et apres traumatisme perineal dans (21%). Parmi les 180 interventions pratiquees, on denombrait 99 uretroplasties (54 uretroplasties anastomotiques, 39 uretroplasties en deux temps et 6 uretroplasties d’elargissement en un temps) et 80 gestes endoscopiques (74 uretrotomies endoscopiques, 2 realignements endoscopiques, 5 mises en place d’endoprotheses). La mediane du suivi etait de 4,5 ans. Les taux de succes ont ete calcules par la methode actuarielle de Kaplan-Meier. Resultats Les taux de resultats satisfaisants des uretroplasties a 1 an et 5 ans, etaient respectivement de 84% et 81% apres uretroplastie anastomotique et de 78% et 53% apres uretroplastie en deux temps. Les meilleurs resultats etaient obtenus lorsque l’uretroplastie anastomotique a ete pratiquee avant toute manipulation endouretrale (95% de resultats satisfaisants a 5 ans). Les uretrotomies realisees pour recidive apres uretroplastie presentaient 70% de resultats satisfaisants a 5 ans. Conclusion L’uretroplastie anastomotique pour stenose traumatique de l’uretre membraneux ou bulbaire donne des resultats d’autant plus satisfaisants et stables qu’elles sont realisees sur un uretre vierge de toute manipulation uretrale anterieure. Les recidives apres uretroplastie de stenose d’origine post-traumatique peuvent etre traitees par uretrotomie endoscopique avec des resultats satisfaisants a long terme.

Les sténoses post-traumatiques de I’urètre : à propos de 105 cas

Treatment of urethral strictures in University of Nigeria Teaching Hospital.

The aim of this manuscript is to review the subject of urethral dilation (UD) in female patients and to conduct a critical appraisal of the available evidence for its use. We used an online search of electronic databases. UD has been cited as a treatment option for various conditions that do not share common etiologies and that affect the lower urinary tract in female patients. Outcome measurement was not consistent, even when performed for the same conditions. A total of six randomized controlled trials failed to prove any benefit for UD in repetitive urinary tract infections (UTI), urethral syndrome, and overactive bladder. Conflicting results and diverse opinions have characterized the use of UD until present time. Professional societies are urged to attend to this issue, and to identify possible areas where UD could be potentially investigated.

Female urethral dilation.

Background. Urethral stricture is a frequent cause of lower urinary tract obstruction worldwide. The aim of this study is to present our experience with one-stage urethroplasty. Methods. All males that underwent one-stage urethroplasty between January 2001 and December 2010 were retrospectively reviewed. Details of their biodata, clinical presentation, diagnostic investigations, operative treatment, postoperative complications, and other outcome of surgery were extracted and analyzed. Results. Ninety-one patients aged 8-76 years, (mean; 45.6 ± 19.7) with urethral stricture were studied. Postinfective strictures accounted for 58.2% and postprostatectomy strictures for 3.3%. Twenty-six (27.9%) of the strictures were in the posterior urethra of which 18 (59.2%) were posttraumatic. Fifty-seven strictures (61.3%) were in the anterior urethra of which 51 (54.8%) were postinfective. Thirty-nine (42.9%) patients had end to end anastomosis, 29 (31.9%) flap augmentation and 17 (18.7%) tabularized flap substitution, and 6 (6.6%) dorsal onlay grafts (5 with buccal mucosa and 1 with penile skin). There were 18 (19.8%) cases of wound infection, 12 (13.2%) of restricture and 6 (6.6%) cases of urethrocutaneous fistula. Satisfactory urinary stream was found in 77 (84.6%) patients. There was no mortality. Conclusion. Infection is the commonest cause of urethral stricture followed by trauma, and one-stage urethroplasty give excellent results.

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One-Stage Urethroplasty for Strictures in Maiduguri, North Eastern Nigeria

Sixty-eight new patients with Urethral Stricture presented at the University of Benin Teaching Hospital Benin City, Nigeria between January 1994 and December 2003, an average of seven patients per year. Forty-two (61.9%) of these patients were aged between 21 and 50 years, 38 (55.9%) of the strictures were traumatic in origin and of these 23 (60.5%) were of the bulbomembranous type and resulted from fractures of the pubic bones. Eight (21.2%) of the traumatic strictures were from iatrogenic causes. Thirty-three (48.5%) of the patients presented without any of the clinical complications of urethral stricture disease. Thirty-four (50.0%) of the patients had treatments other than urethral bouginage. This picture contrasts with the situation in the past when urethral strictures were predominantly post inflammatory in origin. The patients presented more with complications, involved almost entirely bulbar or penile urethral in location and were usually treated by periodic serial dilation.
 Keywords : Urethral stricture, changing patterns. Journal of Medicine and Biomedical Research Vol. 5 (2) 2006: pp. 50-54

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Okay Mbonu

Papers

Treatment of urethral strictures in University of Nigeria Teaching Hospital.

Management of Urethral Injuries in University of Nigeria Teaching Hospital