Management and Outcome of Urethral Strictures at Two Tertiary Health Facilities in Cameroon

Introduction and Objectives: Urethral stricture is a reduction in the caliber of the urethral lumen impeding the outflow of urine. It predominantly affects males. The disease burden is severe in our milieu where access to specialized care is limited. Our goal was therefore to assess the management and outcome of male urethral stricture at two tertiary hospitals in Douala, Cameroon. Materials and Methods: This was a hospital-based retrospective study of patients managed for urethral stricture over 5 years (January 1st, 2017 to December 31st, 2021) at the Douala General and Laquintinie Hospitals. Data on sociodemographic, clinical, paraclinical, and treatment options were extracted using pre-structured forms. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 28. Statistical significance was set at p-value Results: We exploited 130 medical records. The mean age of patients was 46.5 years. Dysuria and weak urine stream were the major presenting complaints (63.8% and 23.8% respectively). The etiology of urethral stricture was iatrogenic in 42.3% of cases. The strictures were mostly single (89.8%), and the bulbar urethra was most affected (46.9%). 28 patients had urinary tract infections and the most frequently isolated germ was E. coli in 29.6%. Direct visual internal urethrotomy (DVIU) was performed in 42.3% of cases. Surgery, especially excision and primary anastomosis (EPA) was done in 28.5% of cases. Major complications were wound infection, acute kidney injury (AKI), and urethrocutaneous fistulae affecting 3.1, 2.3, and 1.5% of cases respectively. The recurrence rate was 17% with a mortality rate of 0.08%. Conclusion: Urethral stricture is common in our adult male population. The cause is mainly iatrogenic and the bulbar urethra is most affected. Minimally invasive and open reconstruction are frequently used treatment options with significant recurrence rates in the long term.

A brief review on anterior urethral strictures

The treatment of urethral strictures remains a challenging field in urology even though there are a variety of procedures to treat it at present,as no one approach is superior over another.This paper reviewed the surgical options for the management of different sites and types of anterior urethral stricture,providing a brief discussion of the controversies regarding this issue and suggesting possible future advancements.Among the existing procedures,simple dilation and direct vision internal urethrotomy are more commonly used for short urethral strictures(<1 cm,soft and no previous intervention).Currently,urethroplasty using buccal mucosa or penile skin is the most widely adopted clinical techniques and have proved successful.Nonetheless,complications such as donor site morbidity remain problem.Tissue engineering techniques are considered as a promising solution for urethral reconstruction,but require further investigation,as does stem cell therapy.

Use of small intestinal submucosa graft for repair of anterior urethral strictures

Objective To investigate the feasibility of using small intestinal submucosa ( SIS) graft for repair of anterior urethral strictures. Methods From June 2009 to August 2010,18 men ( mean age,38 yrs) with anterior urethral strictures underwent urethroplasty using a four layer SIS as an onlay patch graft. SIS was used to

Management of urethral strictures and stenosis caused by the endo-urological treatment of benign prostatic hyperplasiad-a single-center experience

Objective:Urethral stricture disease after endo-urological treatment of benign prostatic hyperplasia(BPH)is a sparsely described complication.We describe management of five categories of these strictures in this retrospective observational case series.Methods:One hundred and twenty-one patients presenting with symptoms of bladder outflow obstruction after endo-urological intervention for BPH from February 2016 to March 2019 were evaluated.Among them,76 were eligible for this study and underwent reconstructive surgery.Preoperative and postoperative assessments were done with symptom scores,uroflowmetry,ultrasound for post-void residue,and urethrogram.Any intervention during follow-up was classed as a failure.The recurrence and 95%confidence interval for recurrence percentage were calculated.Results:The following five categories of patients were identified:Bulbo-membranous(33[43.4%]),navicular fossa(21[27.6%]),penile/peno-bulbar(8[10.5%]),bladder neck stenosis(6[7.9%]),and multiple locations(8[10.5%]).The average age was 69 years(range:60-84 years).Overall average symptom score,flow rate,and post-void residue changed from 21 to 7,6 mL/s to 19 mL/s,and 210 mL to 20 mL,respectively.The average follow-up was 34 months(range:12-58 months).Overall recurrence and complication rates were 10.5%and 9.2%,respectively.The recurrence in each category was seen in 3,1,2,1,and 1 patient,respectively.Overall 95% confidence interval for recurrence percentage was 4.66-19.69.Conclusion:Urethral stricture disease is a major long-term complication of endo-urological treatment of BPH.The bulbo-membranous strictures need continence preserving approach.Navicular fossa strictures require minimally invasive and cosmetic consideration.Peno-bulbar strictures require judicious use of grafts and flaps.Bladder neck stenosis in this cohort could be treated with endoscopic measures.Multiple locations need treatment based on their sites in single-stage as far as possible.

Direct Visual Internal Urethrotomy (DVIU) in the Management of Male Urethral Strictures. A Single Center Experience about 44 Patients

Introduction: Male urethral stricture is one of the oldest urological disorders. Many techniques have been proposed to treat them, including endoscopic internal urethrotomy (DVIU). Material and Methods: To evaluate the contribution of this technique in the treatment of urethra narrowing, a retrospective study on the records of patients with urethral stricture treated with endoscopic internal urethrotomy between January 2014 and December 2021 in the urology division of the Souro Sanou University Teaching Hospital. Results: A total of 44 male patients with urethral stricture were treated with this technique and 48 procedures were performed. The average age of the patients was 53.2 ± 18.2 years. The etiology of the stricture was dominated by iatrogenic, infectious, traumatic and idiopathic causes in 43.2% (n = 19), 27.3% (n = 12), 20.4 % (n = 9), and 9.1% (n = 4) respectively. The location of the stricture was bulbar in 72.7%, and the anterior penile urethra in 15.9%. The overall success rate was 72.7% with satisfactory urination without dysuria, evaluated after removal of the urinary catheter, at three months this rate fell to 69.1%, and at 6 months this rate was 67.5%. Five cases (5) of extravasation of blood or irrigation fluid into the scrotum were reported and managed conservatively as well as two (2) cases of false routes with postoperative oedema of the penis were observed. Conclusion: DVIU is a simple technique, free of major morbidity and requiring only short-term hospitalization. It can be proposed as a first-line treatment for urethral stricture.

A comparative study of buccal mucosa graft and penile pedical flap for reconstruction of anterior urethral strictures

Anterior urethral strictures, where the length is more kthan 2 cm, are best treated by substitution urethroplasty with either preputial/penile skin flaps or free grafts.1 The use of dartos pedicled flaps has many advantages in terms of increased survival thanks to its own vascularization. Recently, buccal mucosa has become increasingly popular among urologists for urethral replacement when local penile skin is unavailable. Both penile skin flaps and buccal mucosa grafts have emerged as reliable urethral substitutes with comparable long-term results. These urethral substitutes are traditionally placed on the ventral aspect of the stricture and have a success rate of about 85%.

Treatment of urethral strictures using lingual mucosas urethroplasty： experience of 92 cases

Background Urethroplasty of complex urethral stricture is a difficult procedure, and there is no widely accepted standard approach described in the published literature. We evaluated the efficacy and safety of urethroplasty using lingual mucosa grafts （LMGs） for the repair of urethral strictures. Methods Between August 2006 and April 2009, 92 cases of urethral strictures （length ranging from 2.5 cm to 18 cm, mean 6.5 cm） were treated using LMGs. Of the 92 patients, 38 with long-segment urethral strictures （9-18 cm） underwent dual LMG or LMG combined with foreskin flap or buccal mucosal graft urethroplasty. Results Follow-up was obtained for 3-33 months （mean 17.2 months） postoperatively. Complications occurred in 8 patients, including urinary fistulas in 4 patients; recurrent strictures developed in 4 patients at 3-4 months post-operatively. The remaining patients voided well postoperatively, with peak flows between 14.3 ml/s and 54.6 ml/s （mean 28.4 ml/s）. Conclusions The tongue is an excellent source of graft material for the repair of anterior mucosal strictures. Dual LMG substitution urethroplasty can successfully treat longer, more complex urethral strictures.

A comparative study of two single-stage oral mucosal substitution urethroplasty(Kulkarni and Asopa)in the surgical treatments of lichen sclerosus urethral strictures

Long-segment lichen sclerosus(LS)urethral stricture is a challenge for urologists.Limited data are available for surgeons to make a surgical decision between Kulkarni and Asopa urethroplasty.In this retrospective study,we investigated the outcomes of these two procedures in patients with LS urethral stricture.Between January 2015 and December 2020,77 patients with LS urethral stricture underwent Kulkarni and Asopa procedures for urethroplasty in the Department of Urology,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine(Shanghai,China).Of the 77 patients,42(54.5%)underwent the Asopa procedure and 35(45.5%)underwent the Kulkarni procedure.The overall complication rate was 34.2%in the Kulkarni group and 19.0%in the Asopa group,and no difference was observed(P=0.105).Among the complications,no statistical difference was observed in the incidence of urethral stricture recurrence(P=0.724)or glans dehiscence(P=0.246)except for postoperative meatus stenosis(P=0.020).However,the recurrence-free survival rate between the two procedures was significantly different(P=0.016).Cox survival analysis showed that antiplatelet/anticoagulant therapy use(P=0.020),diabetes(P=0.003),current/former smoking(P=0.019),coronary heart disease(P<0.001),and stricture length(P=0.028)may lead to a higher hazard ratio of complications.Even so,these two techniques can still provide acceptable results with their own advantages in the surgical treatment of LS urethral strictures.The surgical alternative should be considered comprehensively according to the patient characteristics and surgeon preferences.Moreover,our results showed that antiplatelet/anticoagulant therapy use,diabetes,coronary heart disease,current/former smoking,and stricture length may be contributing factors of complications.Therefore,patients with LS are advised to undergo early interventions for better therapeutic effects.

Double-face urethroplasty in patients with obliterative bulbar strictures post-transurethral resection of the prostate mid-term outcomes in high-volume referral center

Objective Incidences of post-transurethral resection of the prostate(post-TURP)strictures are between 2.2%and 9.8%.Stricture commonly occurs within the first 6 months.Our objective was to assess the outcomes of patients with obliterative strictures post-TURP that underwent a double-face urethroplasty.Methods This is a single-center prospective study of 17 patients with obliterative proximal bulbar stricture post-TURP who underwent double-face graft urethroplasty by two surgeons between January 2014 and January 2020.We defined post-TURP obliterative strictures as those patients who presented with complete or almost complete obstruction of the urethral lumen and who have had a history of acute urine retention.We have excluded patients with bladder neck contracture.Primary outcome was treatment success,defined as the no need for further treatments.Secondary outcome was post-urethroplasty continent rate.Results Seventeen patients were included in the study with median age of 66(interquartile range 40-77)years;median time of follow-up was 24(interquartile range 12-84)months;median stricture length was 4(interquartile range 2-6)cm.Of the 17 patients,15(88.2%)were successful.All patients were continent after urethroplasty.Conclusion With mid-term follow-up,treatment of obliterative proximal bulbar strictures with double-face buccal mucosa graft is a safe and effective procedure.Obliterative proximal bulbar strictures merit double-face urethroplasty with high-rate success and functional outcomes.

Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures

Objective： To elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result. Methods： We reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients＇ age ranged from 8 to 53 years （mean 27 years ）. Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years （ mean 8 years ）. Results： Among the 77 patients treated by perineal approaches, 69 （95.8 % ） were successfully repaired and 27 out of the 29 patients （93. 1% ） who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases.Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery. Conclusions： Three important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucnsa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2. 5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2. 5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely （5.7 % ） to urethroplasty.

Management of urethral strictures after masculinizing genital surgery in transgender men

Transgender men undergoing phalloplasty and metoidioplasty have a high rate of urethral stricture.Evaluation of stricture includes evaluation of symptoms and uroflow,cystoscopy,and retrograde urethrogram.Important anatomic differences between the phallus of cis-gender and transgender men increase the likelihood and complexity of treating urethral strictures in transgender men after surgery.Urethral strictures after masculinizing procedures are more likely to require open surgical treatment and recur after treatment.There is a paucity of data,but less invasive options such as dilation and urethrotomy have had minimal success.Open surgical options with a variety of techniques,including one-stage and two-stage techniques,have higher success rates in treating strictures,but there is minimal comparative data on outcomes.We present a review on management options for urethral reconstruction in transgender men and our data on urethroplasty for these patients.

Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study

Objective:To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation(BD)for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence.Methods:This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019.Data about the patient age,stricture characteristics,and recurrence date were recorded,along with information on postoperative indwelling catheter use and operative complications.Furthermore,information about the self-calibration procedure was collected and where available,free flow(FF)measurements during the follow-up period were recorded and analyzed.Success was defined as a lack of symptoms and acceptable FF rates(maximum flow rate>12 mL/s).Results:The final analysis was conducted on 187 patients.The mean follow-up period was 37 months.The long-term overall success rate at the end of our study was 66.8%.Our recurrence rate was 7.4%at 12 months,24.7%at 24 months,and reached 33.2%at the end of our study.The time to recurrence ranged from 91 days to 1635 days,with a mean of 670 days.The stricture-free survival was significantly shorter with lengthy peno-bulbar(p=0.031)and multiple strictures(p=0.015),and in the group of patients who were not committed to self-calibration protocol(p<0.011).However,post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence(odds ratioZ5.85).Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4%in the non-self-calibration group to 15.1%in the self-calibration one(p<0.001),but also improved the overall stricture-free survival and FF parameters.

Analysis of the urethral stricture score and patient-related factors as predictors of outcomes following oral mucosal graft urethroplasty

Objective:The complexity of urethral strictures can predict outcomes following urethroplasty.The previously described urethral stricture score(U score)considered only stricture-related factors to grade the complexity of urethral strictures and to predict recurrence post urethroplasty,but not considered patient-related factors for the same.We aimed to study the correlation of both of these factors to the outcomes of oral mucosal graft urethroplasty.Methods:We retrospectively reviewed data of 101 patients who underwent oral mucosal graft urethroplasty in our institute with a minimum follow-up of 6 months.Baseline patient characteristics and stricture-related parameters were noted.The U score was calculated for all patients which consisted of the length,location,number,and etiology of stricture.Univariate and multivariate Cox proportional hazard regression models were used to determine significant risk factors of recurrence.Results:The mean follow-up of patients was 15 months.Recurrence was seen in 28 patients and the mean time for detection of recurrence was 8 months of follow-up.The Charlson Comorbidity Index,history of previous intervention,length of strictures,location of strictures,number of strictures,history of smoking,and etiology were independent predictors of recurrence following urethroplasty.Based on these parameters,we formulated the modified U score(MU score).The scores ranged from 0 to 6 and a score of>2 was found to be predictive of recurrence.On comparing receiver operating characteristic curves for both scores by the DeLong test,the MU score had larger area under the curve than the U score.Conclusion:The MU scoring system is the first of its kind attempt taking into consideration both patient-and stricture-related factors to predict recurrence following oral mucosal graft urethroplasty.

Dorsal onlay buccal mucosal graft urethroplasty for female urethral stricture:Techniques and outcomes

ObjectiveFemale urethral stricture (FUS) accounts for about 4%–13% of cases of female bladder outlet obstruction. FUS was and is still managed by repeated dilatations and/or direct visual internal urethrotomy. There are many alternative options for reconstruction like buccal or vaginal mucosal graft urethroplasty. Our aim was to describe the technique of dorsal onlay buccal mucosal graft (BMG) urethroplasty for FUS and present the outcomes.MethodsBetween January 2014 and December 2021, 37 patients who underwent dorsal onlay BMG urethroplasty were included in the study. Their pre-operative diagnosis was confirmed with uroflowmetry, micturating cystourethrogram, urethral calibration, and on table cystoscopy. Bladder catheter was removed after 2 weeks. Patients were followed up at 3 months, 6 months, 1 year, and then annually with urine analysis, uroflowmetry, and post-void residual assessment. We defined success as a maximum flow rate (Q_(max)) above 15 mL/s without the need for an additional instrumentation.ResultsThe mean age of patients was 47.8 (standard deviation [SD] 11.3) years. Twenty patients had previously undergone urethral dilatations. The mean pre-operative Q_(max) was 7.79 (SD 3.73) mL/s. However, the mean Q_(max) improved to 23.20 (SD 8.25) mL/s after surgery. The mean post-void residual urine after surgery was 30.50 (SD 10.70) mL. This reduced from a mean value of 139.00 (SD 147.24) mL before surgery. The mean follow-up was 30.2 (SD 18.3, range 18–44) months. There was no post-operative incontinence. There were Clavien–Dindo Grade 1 complications in 6 out of 37 (16.2 %) patients during hospital stay. The only long-term complication was recurrence of stricture in 4 (10.8%) patients.ConclusionDorsal onlay BMG urethroplasty in females is a safe, effective technique which can avoid repeated painful dilatations and multiple urethrotomies. One should always consider reconstruction in FUS without any fear of incontinence.

Prospective randomized study correlating intra-operative urethral mucosal injury with early period after transurethral resection of the prostate stricture urethra: A novel concept

Objective:To investigate the incidence of urethral stricture during the early period after transurethral resection of the prostate(TURP)and correlate its incidence with intra-operative urethral mucosal injury during TURP.Also to compare the other established risk factors affecting the development of urethral stricture among patients undergoing monopolar or bipolar TURP over a period of 6 months follow-up as the prospective randomized study.Methods:One hundred and fifty men older than 50 years with lower-urinary tract symptoms associated with benign prostatic hyperplasia were randomized to undergo either standard monopolar TURP with glycine as the irrigation fluid or bipolar TURP with normal saline as irrigant.The prostate size,operative time,intra-operative mucosal rupture,catheter time,catheter traction duration,uroflowmetry,and post-operative stricture rate were compared.Results:A total of 150 patients underwent TURP,including 74 patients undergoing monopolar TURP(one patient was excluded as his post-operative histopathological examination report was of adenocarcinoma prostate)and 75 patients undergoing bipolar-TURP,all of which were performed using a 26 Fr sheath resectoscope.The mean International Prostate Symptom Score and maximum urinary flow rate score at post-operative 3 months and 6 months were comparable between the groups.Out of 149 patients,nine patients(6.0%)developed urethral stricture.The severity of the injury(urethral mucosal injury)correlated with the likelihood of developing a subsequent complication(stricture urethra).Patients with stricture had significantly larger prostate volume than patients without stricture(65.0 mL vs.50.0 mL;p=0.030).Patients with stricture had longer operative time than patients without stricture(55.0 min vs.40.0 min;p=0.002).In both procedures,formation of post-operative stricture urethra was independently associated with intra-operative mucosal injury.Conclusion:Intra-operative recognition of urethral mucosal injury helps in prediction of stricture urethra formation in early post-operative period.

Investigation of risk factors in the development of recurrent urethral stricture after internal urethrotomy

BACKGROUND Urethral stricture is a condition that often develops with trauma and results in narrowing of the urethral lumen.Although endoscopic methods are mostly used in its treatment,it has high recurrence rates.Therefore,open urethroplasty is recommended after unsuccessful endoscopic treatments.AIM To investigate the risk factors associated with urethral stricture recurrence.METHODS The data of male patients who underwent internal urethrotomy for urethral stricture between January 2017 and January 2023 were retrospectively analyzed.Demographic data,comorbidities,preoperative haemogram,and biochemical values obtained from peripheral blood and operative data were recorded.Patients were divided into two groups in terms of recurrence development;recurrence and non-recurrence.Initially recorded data were compared between the two groups.RESULTS A total of 303 patients were included in the study.The mean age of the patients was 66.6±13.6 years.The mean duration of recurrence development was 9.63±9.84(min-max:1-39)months in the recurrence group.Recurrence did not occur in non-recurrence group throughout the follow-up period with an average time of 44.15±24.07(min-max:12-84)months.In the comparison of both groups,the presence of diabetes mellitus(DM),hypertension(HT),and multiple comorbidi-ties were significantly higher in the recurrence(+)group(P=0.038,P=0.012,P=0.013).Blood group,postoperative use of non-steroidal anti-inflammatory drugs,preoperative cystostomy,cause of stricture,iatrogenic cause of stricture,location and length of stricture,indwelling urinary cathater size and day of catheter removal did not differ between the two groups.No statistically significant difference was observed between the two groups in terms of age,uroflowmetric maximum flow rate value,hemo-gram parameters,aspartate aminotransferase(AST),alanine aminotransferase(ALT),fasting blood sugar,creati-nine,glomerular filtration rate,neutrophil-lymphocyte ratio,platelet-lymphocyte ratio,lymphocyte-monocyte ratio,monocyte-lymphocyte ratio and AST/ALT ratios.CONCLUSION In patients with urethral stricture recurrence,only the frequency of DM and HT was high,while inflammation marker levels and stricture-related parameters were similar between the groups.

Long-term study of male rabbit urethral mucosa reconstruction using epidermal cell

Aim： To investigate the transformation of characteristics of epidermal cells from foreskin which were used to reconstruct male rabbit anterior urethra in combination with acellular collagen matrices. Methods： In three rabbits, autologous foreskin epidermal cells were isolated, expanded in vitro, and seeded （inoculated） onto a tubular acellular collagen matrix, acquired from allogeneic rabbit bladder submucosa. A urethral mucosal defect was created, and urethral reconstruction was performed with the tubular acellular collagen matrix seeded with epidermal cells. Results： On gross examination at 12 months following the procedure, the mucosa of the urethral grafts appeared lubricous and smooth. Urethrography showed that a wide urethral caliber had been maintained without any sign of strictures. Histological examination showed a transitional cell layer in the graft without evidence of a margin between the graft and the host tissue at 12 months postoperatively. Conclusion： Epidermal cells seeded onto acellular collagen matrices can be successfully used to reconstruct urethras that have defects and are transformed to transitional epithelial cells.

Erectile function after urethral reconstruction

Advances in urogenital plastic surgical tissue transfer techniques have enabled urethral reconstruction surgery to become the new gold-standard for treatment of refractory urethral stricture disease. Questions remain, however, regarding the long-term implications on sexual function after major genital reconstructive surgery. In this article, we review the pathologic features of urethral stricture disease and urologic trauma that may affect erectile function （EF） and assess the impact of various specific contemporary urethroplasty surgical techniques on male sexual function.

Evaluation of erectile function after urethral reconstruction:a prospective study

We conducted a prospective study of erectile dysfunction(ED)after urethral reconstructive surgery,using the 5-item International Index of Erectile Function(IIEF-5),the Sexual Life Quality Questionnaire(SLQQ)and the Quality of Life Questionnaire(QoLQ).Between January 2003 and July 2007,125 male patients with urethral strictures underwent urethroplasty,and pre-and post-surgery erectile function was assessed using these three questionnaires.A formula to predict the probability of ED after urethroplasty was derived.At 3 months post-operatively,there was a significant decrease in IIEF-5(16.57±7.98)and SLQQ scores(28.71±14.84)compared with pre-operative scores(P<0.05).However,the IIEF-5 scores rebounded at 6 months post-operatively(17.22±8.41).Logistical regression analysis showed that the location of the urethral stricture,the recurrence of strictures and the choice of surgical technique were predictive of the post-operative occurrence of ED.This study identified the clinical risk factors for ED after urethroplasty.Posterior urethral stricture and end-to-end anastomosis were found to have a strong relationship with erectile function.The logistical model derived in this study may be applied to clinical decision algorithms for patients with urethral strictures.

The treatment of complex female urethral pathology

Lower urinary tract symptoms(LUTS)in women produce significant bother.Common conditions causing LUTS in women include urinary tract infections,overactive bladder,and stress incontinence.Urethral diverticulae and female urethral strictures are rare pathologies.They can cause symptoms,which can mimic commoner conditions,leading to delay in diagnosis and unnecessary delay in treatment.In this article,we discuss in detail the definition,symptoms,epidemiology,pathogenesis,diagnosis,and treatment option for these two conditions.Further understanding of these conditions will aid in the proper diagnosis and prevent delay in management.