Contemporary Evaluation and Treatment of Male Urethral Stricture Disease in West Africa

Urethral stricture is a common cause of morbidity and sometime mortality in West Africa. A variety of investigative tool and techniques are currently available to evaluate and manage this condition. Major urological societies have issued evidence based guidelines for the evaluation and management of this disease. In Ghana and West Africa the resources available in the developed world may not be available. The patient population is different with most patients presenting with complications like acute urinary retention. Therefore evidence based guidelines may not be strictly adhered to. We performed a retrospective audit of the evaluation and management of urethral stricture at Korle Bu Teaching hospital in Accra Ghana between November 2011 and November 2012 and compared our findings with published studies from the sub region. Post inflammatory strictures predominate but the percentage is decreasing due to the rapid increase in the incidence of pelvic fracture urethral injury. To reduce the cost of investigation a thorough history and physical examination is essential, imaging tests performed are those that will influence management plan. Although urethrotomy and dilatation are not curative, patients who otherwise would have benefited from urethroplasty are still offered repeated urethrotomy because of lack of theatre space and trained surgeons to perform urethroplasty. For the same reason many patients in the sub region spend many months to years with a suprapubic catheter.