Research articles

By Prof. Wilson Onuigbo , Dr. Gabriel .E. Njeze
Corresponding Author Prof. Wilson Onuigbo
Histopathology, The National Orthopaedic Hospital, Abakpa-Nike, Enugu - Nigeria 400001
Submitting Author Prof. Wilson I Onuigbo
Other Authors Dr. Gabriel .E. Njeze
Trans Ekulu, Surgery Deparment, - Nigeria 400001


Prostatectomy; Urethra, Stricture; Elderly; Dilation

Onuigbo W, Njeze G. Postprostatectomy Urethral Stricture in Elderly Nigerians. WebmedCentral CANCER 2012;3(10):WMC00786
doi: 10.9754/journal.wmc.2012.00786

This is an open-access article distributed under the terms of the Creative Commons Attribution License(CC-BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Submitted on: 08 Oct 2012 12:08:52 PM GMT
Published on: 08 Oct 2012 06:56:40 PM GMT



We examined the outcome of urethral dilation in elderly patients of the Igbo ethnic group in Nigeria for stricture that supervened on radical prostatectomy.


In this study, 10 men aged 65 years or older with proved urethral strictures underwent dilation. Their disease followed radical prostatectomy during the period from February, 1993 to December, 2005. The dilation was made under spinal (intrathecal) anesthesia.


In this patient cohort, we found that urethral dilation was undertaken without difficulty. Urine flow was stated to be good during follow up of up to 2 years.


The predictive value of urethral dilation is such that it can be offered to elderly patients whose stricture resulted from prostatectomy.


Urethral stricture is a common urological disease seen in hospital practice across Nigeria.In one center,1 out of 123 patients treated during 2 years, 57 were due to trauma but only 4 of these resulted from prostatectomy. In another center,2 out of 45 cases seen during 3 years, none was reported to have resulted from surgery, although two were categorized as “Aetiology uncertain.” Therefore, we propose to bring to notice our wider experience of this group which seems to have required multicenter study3 in a developed country.

Materials and Methods

From February 1993 to December 2005, patients who had urethral strictures were studied at the Trans Ekulu Hospital in Enugu, Nigeria. They belonged to the Ibos or Igbos, who constitute one of the three main Ethnic Groups.4 Mode of presentation, was noted, while the baseline studies included hemoglobin, urinalysis, urine culture and sensitivity, serum electrolytes, urea and creatinine. Retrograde urethrogram was also done to confirm the strictures. Dilation was the only mode of treatment offered. After treatment, the patients were followed up for at least 2 years. The outcome, classified as poor or good, was based on each patient’s judgment of the satisfactory flow of urine.


Out of 56 patients, who presented with urethral strictures, 12 were aged 65 years to 92 years, their average age being 70 years. Five patients (41.6%) were aged between 65—69 years, another 6 patients (50%) were aged between 70 and 80 years and 1 patient (8.3%) were aged 92 years. Among them, complications of prostatectomy accounted for 10 cases. These patients underwent urethral dilation under spinal (intrathecal) anesthesia without difficulty.  They did well after urethral dilation and had satisfactory urine flow. There was no mortality and the results were generally classified as good.


    In the setting of an increasingly ageing population, surgical procedures proportionately increase as part of medical effort to deal with the health problems of the elderly.5  Fortunately, the elderly are known to cope easily with simple operations where there is no risk of bleeding or significant infection.6  Since treatment of infection in the elderly is a major concern, if the patients suffering from both urethral stricture and infected urine are treated with guidance from urine culture and sensitivity studies, and if the operative procedure has been carefully and properly planned, the result should be rewarding. Untreated, these patients lead a miserable life because of the agony associated with micturition, and the terrible smell of badly infected urine.

Incidentally, none of our patients had urethroplasty because of lack of facilities. Long ago, Badenoch7 actually advocated dilation as a good treatment option, as long as the patient can be kept comfortable on easy infrequent dilation.  Recently, in this Journal,8 Steenkamp, Heynes, and de Kock concluded that “There is no significant difference in efficacy between dilation and internal urethrotomy as initial treatment for strictures.”  Certainly, urodynamic factors are important in relation to outcome of prostatectomy.9  Accordingly, experience gained from treating our own patients has confirmed that age is not an absolute contraindication to the above management. Indeed, elderly patients, who presented for local dilation treatment, are manifestly enjoying more years of quality life in our community.


1. Osegbe DN, Arogundade RA. Changing pattern of urethral stricture in Nigerians. Nig Postgrad Med J 1994;1:1-5.
2. Essiet A, Irekpita EE, Ekwere PD, et al. Management of urethral strictures in the UCTH Calabar. Nig Postgrad Med J 2007;14:50-53.
3. Kao T-C, Cruess DF, Garner D, et al. Multicenter patient self-reporting questionnaire on impotence, incontinence and stricture after radical prostatectomy. J Urol 2000;163:858-864.
4. Basden GT. Niger Ibos. London: Cass, 1966.
5. Harbrecht PJ, Garrison RN. Surgery in elderly patients. South Med J 1981;74:594-598.
6. Fleiser LA, Pastermak IR, Herbert R. Inpatient hospital admission and death after day surgery in elderly patients. Arch Surg 2004;139:67-71.
7. Badenoch AW. Traumatic stricture of the urethra. Br J Urol 1968;40:671-676.
8. Steenkamp JW, Heynes CF, de Kock MLS. Internal urethrotomy versus dilation as treatment for male urethral strictures: a prospective, randomized comparison. J Urol 1997;157:98-101.
9. Ball AJ, Smith PJB. Urodynamic factors in relation to outcome of prostatectomy. Urology 1986;28:256-258.

Source(s) of Funding

Sole funding

Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

3 reviews posted so far

Postprostatectomy Urethral Stricture in Elderly Nigerians: critical review
Posted by Anonymous Reviewer on 08 Oct 2012 08:31:58 PM GMT

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)