Specific characteristics of urethral strictures in a developing country (Brazil).
Astolfi RH1, Lebani BR1, Krebs RK2, Dias-Filho AC3, Bissoli J4, Cavalcanti AG5, Ximenes SF1,6, Bertolla RP1, Geminiani JJ7.
Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil.
Division of Urology, Paraná Federal University (UFPR), Curitiba, Brazil.
Division of Urology, Federal District Base Hospital, Brasília, Brazil.
Division of Urology, University of São Paulo Medical School (FMUSP), São Paulo, Brazil.
Urogenital Research Unit from Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil.
Oswaldo Ramos Foundation, São Paulo, Brazil.
Department of Surgery, Division of Urology, Sao Paulo Federal University (UNIFESP), São Paulo, Brazil. email@example.com.
Evaluate the main etiologies and clinical characteristics of male urethral stricture disease (USD) in Brazil.
This multicentric study was performed using retrospective data collected from six Brazilian referral centers of urethral reconstruction. The database comprised data from 899 patients with USD who had undergone surgical treatment from 2008 to 2018. Age, stricture site and primary stricture etiology were identified for each patient.
The mean age was 52.13 ± 16.9 years. The most common etiology was iatrogenic (43.4%), followed by idiopathic (21.7%), trauma (21.5%) and inflammatory (13.7%). Of the iatrogenic causes, 59% were secondary to urethral instrumentation (60% by urethral catheterization and 40% by transurethral procedures), 24.8% by other procedures (prostatectomy, radiotherapy, postectomy) and 16.2% by failed hypospadia repairs. Pelvic fracture urethral distraction injuries were responsible for most of the trauma-related strictures (62.7%). When stratified by age, the most common stricture etiology was trauma in the 0-39 years old group (42.8%), idiopathic in the 40-59 years old group (32.4%) and iatrogenic in patients over 60 years old (68%). In regard to the stricture site, 80% presented with an anterior urethral stricture and 20% with a posterior stenosis. In the anterior stenosis group, the most common stricture site was bulbar (39.5%).
In Brazil, as in many developed countries, the most common cause of urethral stricture diseases is iatrogenic, especially urethral catheterization. These findings emphasize the need of a careful urethral manipulation and a better training of healthcare professionals. Trauma is still responsible for a great proportion of strictures and inflammatory etiologies are now less frequently observed.
Ethiology; Iatrogenic disease; Lichen sclerosus; Urethral stricure; Urethritis; Urinary catheterization