A Study to compare the short term outcome of urethral structure disease management between HIV and Non HIV infected patinets at UTH

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Silumbe, Michael
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Background: According to Steencamp et al (1997), urethral stricture disease is one of the oldest known urological diseases and remains a common problem with a high morbidity despite earlier predictions to the contrary. In many third world countries with limited medical resources male urethral stricture disease remains highly prevalent. STIs cause urethritis which is an aetiology for urethral stricture disease and urethritis is a risk factor for HIV transmission (De Schryver and Meheus, 1990). The outcome of surgery has been found to be affected by the immune status of the patient and HIV has a bearing on the outcome. Urethral stricture disease is thus not an exception. This study intended to compare short term outcome of treatment of urethral stricture disease between HIV seropositive and HIV seronegative patients at the UTH in Lusaka. Patients and Methods: This was a prospective cohort study conducted on patients presenting with virgin urethral stricture disease at the University Teaching Hospital (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 two groups. Other parameters studied included patients demographics, CD4 cell count in positive patients, HIV WHO stage, stricture aetiology, stricture site and stricture length. The collected data was analysed using SPSS 16. Results: A total of 71 patients with a mean age of 38.04 years who had urethral stricture disease were recruited in this study. 37% (n=26) were HIV seropositive while 63% (n=45) were seronegative and 53.8% (n=14) of the seropositive patients were on HAART. 45% (n=32) of urethral strictures resulted from urethritis and the prevalence of HIV in patients presenting with post urethritis stricture disease was 50% (n=16/32). In terms of stricture location, 73.2% (n=52) of strictures were located in the bulbar urethra, 19.7% (n=14) had strictures in the penile urethra and 5.6% (n=4) had strictures located in the membranous urethra. The operation types included urethral dilatation, anastomotic urethroplasty and staged urethroplasty. 73% (n=52) of the patients had urethral dilatation, 17% (n=12) had anastomotic urethroplasty and 10% (n=7) had staged urethroplasty. The intraoperative complication rate in this study was 2.8% (n=2) while postoperatively it was 12.7% (n=9). 55.2% (n=32/58) had urethral stricture disease recurrence after being followed up for 6 months. Urethral dilatation accounted for most of the failures as 28% (n=20/58) of the patients who had urethral dilatation had recurrence. With regard to HIV status, 47% (n=16/34) of the non reactive patients had recurrence while 67% (n=16/24) of the reactive patients had recurrence. However, the 20% difference in recurrence between reactive and non reactive patients was statistically insignificance (p=0.139). Conclusions: 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 Cum survival of urethral stricture disease following treatment are also not influenced by the HIV status of the patient
Urethra--Disease , Urethra--stricture