Micturition Related Quality of Life in Substitutional Urethroplasties and Its Determinants as Seen in Kenyatta National Hospital

Abstract

Introduction: Urethral strictures are a common occurrence in Kenya. Substitution urethroplasty is considered for patients with long strictures. Long term outcomes of patients treated for urethral stricture with substitution urethroplasty are not well known in this region. This hinders adequate evaluation of the successes and failures of this procedure. Objectives: The main objective of this study was to evaluate the micturition related quality of life and its determinants after undergoing substitution urethroplasty for urethral stricture. Methodology: This was a cross-sectional study. The study included 80 adult male patients who underwent treatment for urethral stricture using substitution urethroplasty. Patients who underwent urethroplasty were called back to the hospital or recruited during routine follow-up clinic visits. Data was collected on current state of micturating quality of life as measured by the American Urological Association-Symptom Index (AUA-SI) score (outcome variable). Exposure variables included, duration since surgery, number of prior procedures, length, and location of stricture. Results: The mean age was 48.3 years, SD 15.3, range (18 – 82). Pan urethral strictures were most common at 28.8% followed by penile at 21.3%. The mean length of stricture was 3.93cm, SD 2.2, median 3.8, Range (1 – 10 cm). Dorsal on-lay procedures were 71.3% compared with 28.8% for ventral on-lay procedures. Majority of patients had no prior urethroplasty (38.5%), with 21.8% having a single previous failed procedure while 32.1% had two prior unsuccessful procedures. The mean AUA SI score pre-operatively was 25.1, SD 7.7 compared to post-operatively at 9.2, SD 7.0 with a statistically significant difference of p<0.001. The most important determinants of post-operative AUA SI score were length of stricture (p=0.001) and the number of previous procedures (p=0.001). Determination of level of patient satisfaction using USS PROM questionnaire revealed that 67.5% of patients were satisfied with the procedure with 51.3% reporting that urinary symptoms did not interfere with their day-to-day life and 20% reporting little interference. When assessing for incontinence, 46.3% reported some degree of urine leak. Conclusion: Substitution urethroplasty is a commonly performed procedure at the Kenyatta National Hospital (KNH) just like in many urology hospitals. From the foregoing study the procedure is effective in improving the AUA-SI score and satisfaction among patients but less effective in circumventing the complication of post-operative urinary incontinence. Notable is that the satisfaction compared to other centers is lesser at the KNH. Similarly, the rates of urinary incontinence are comparably high in our center compared to other centers.