Purpose: This study intends to compare short-term outcomes of treatment of urethral stricture disease between human immunodeficiency virus (HIV) seropositive and HIV seronegative patients at the University Teaching Hospital (UTH) in Lusaka.
Methods: This was a prospective cohort study conducted on patients presenting with urethral stricture disease at the UTH, Lusaka, Zambia, between October 2009 and December 2010. One arm included HIV seropositive patients and the other arm had HIV seronegative patients. The recruited patients underwent urethral dilatation, anastomotic urethroplasty, and staged urethroplasty. They were followed-up postoperatively for 6 months, and recurrence and complication rates were compared between the 2 groups. Other parameters studied included patient demographics, cluster of differentiation (CD4) cell counts in positive patients, HIV World Health Organization (WHO) stages, stricture etiology, stricture sites, and stricture lengths. The collected data was analyzed using SPSS 16.
Results: A total of 71 patients with a mean age of 38.04 years who had urethral stricture disease were recruited for this study. Of the patients, 37% (26) were HIV seropositive while 63% (45) were seronegative, and 53.8% (14) of the seropositive patients were on highly active antiretroviral therapy (HAART). Of the urethral strictures, 45% (32) resulted from urethritis, and the prevalence of HIV in patients presenting with post-urethritis stricture disease was 50% (16/32). Of the strictures, 73.2% (N = 52) were located in the bulbar urethra, 19.7% (N = 14) were in the penile urethra, and 5.6% (N = 4) were located in the membranous urethra. Of the patients, 73% (N = 52) had urethral dilatation, 17% (N = 12) had anastomotic urethroplasty, and 10% (N = 7) had staged urethroplasty. The overall intraoperative complication rate was 2.8% (2) while postoperatively it was 12.7% (9); 55.2% (32/58) had urethral stricture disease recurrence after being followed-up for 6 months, with urethral dilatation accounting for most of the failures (28% (20/58)). Of the non-reactive patients, 47% (16/34) had recurrence while 67% (16/24) had recurrence. However, the 20% difference in recurrence between reactive and non-reactive patients was statistically insignificant (P = 0.139).
Conclusion: Urethral stricture disease affects patients from all age groups. The prevalence of HIV in patients with post-urethritis stricture disease is high. Stricture recurrence following treatment is not affected by the HIV status of the patient and CD4cc, although it is affected by stricture site and stricture length. Time to recurrence and cumulative survival of urethral stricture disease following treatment are also not influenced by the HIV status of the patient.
Mohamed Awny Labib, Michael Silumbe, Kasonde Bowa
Submitted April 30, 2012 - Accepted for Publication December 27, 2012
KEYWORDS: Aetiology, site, stricture, urethra
CORRESPONDENCE: Mohamed Awny Labib, FRCS (Ed), University Teaching Hospital, Lusaka, Central Zambia, Africa ()
CITATION: UroToday Int J. 2013 February;6(1):art 6. http://dx.doi.org/10.3834/uij.1944-5784.2013.02.06