​What kinds of symptoms do patients experience before receiving treatment?

Urethral stricture is the diagnosis that warrants a urethroplasty. Urethral stricture is caused by inflammation of tissue or the existence of scar tissue – either of which may result in constricting the urethra. Symptoms of urethral stricture include a weak flow of urine or a decreased volume of urine, urethral discharge, evidence of blood in semen or urine, discolouration of urine, inability to urinate, pain in the pelvic or lower abdominal area, pain or burning during urination, and urinary frequency/urgency.

​What is the impact on patients’ lives of living with these conditions?

This condition can make it difficult for an individual to work, especially for those involved in manual labour. The urgent and frequent need to urinate can cause complications in the workplace. There is also a level of pain and discomfort that can cause complications for the individual. There is also a risk that the patient will not be able to pass urine at all, leading to kidney failure.

What cultural or regional factors affect the treatment of these conditions?

Historically there are no serious social implications for urethral strictures in Kenya. Urethral strictures are sometimes a result of sexually transmitted illnesses, which do entail social stigma.

What does the treatment process look like?

The surgery entails either removing the constricted portion of the urethra or enlarging it. A urethroplasty may also include the reconstruction of tissues surrounding the urethra. In such cases, tissues from the skin or mouth may be grafted to aid in the reconstruction. After surgery, a urethral catheter is implanted for two to four weeks following the procedure. The treatment typically lasts between three to six hours. Most patients can be discharged immediately following the surgery or within one day following the surgery.

What is the impact of this treatment on the patient’s life?

The treatment is highly effective and the percentage of individuals who develop strictures following the treatment is very low. Patients are recommended to allow three to four weeks of recovery before returning to work, particularly for those involved in manual labour. For those working non physically intensive jobs, it is possible to resume working one to two weeks following the procedure. Once the urethra has healed properly, the catheter can be removed and the patient will resume normal urination.

What potential side effects or risks come with this treatment?

Similar to most other surgeries, the pain is the most intense in the twelve hours immediately following the procedure but will decrease with time. By the following day, the pain should be at a comfortable level and for the next few days, the pain should remain a dull ache but nothing more. There is the possibility of a bladder spasm which would be indicated by sudden pain in the penis, pubic bone, or lower abdomen. A bladder spasm is pain caused by the catheter and can be treated with medicines. There is a small possibility of strictures returning but in such an event, only half of the cases report symptoms.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are some tertiary care centres spread out in Kenya that offer this treatment. The difficulty, however, is securing a surgery date in a timely manner.

What are the alternatives to this treatment?

Alternatives to a urethroplasty include the widening of the urethra as done by a dilator. This can be performed by a doctor passing a small wire through the urethra and into the bladder. Unlike the urethroplasty, this procedure will gradually increase the size of the urethra as opposed to immediately. A second option is the insertion of a permanent urinary catheter. This is typically reserved for severe cases, especially because of the risk it poses for bladder irritation and urinary tract infections.