The clinical spectrum of the presenting signs and symptoms of anterior urethral stricture: detailed analysis of a single institutional cohort.

OBJECTIVE: To accurately delineate the presentation of anterior urethral stricture in an economically developed patient cohort. It is widely assumed that patients with urethral stricture typically present with lower urinary tract symptoms (LUTS). There is a paucity of data examining this assumption. With no uniformly accepted clinical definition or measure of treatment success, a clear clinical description of urethral stricture is important.

METHODS: Retrospective detailed analysis was performed on 611 patients presenting with anterior urethral stricture from July 2004 to June 2010. Both the presenting complaint and associated signs and symptoms were classified according to one of 10 clinical categories.

RESULTS: The most common presenting complaint was LUTS typical of those found on the American Urological Association-Symptom Score (54.3%) and another 23.4% of patients presented initially with acute urinary retention (AUR). Symptoms other than LUTS or urinary retention accounted for 22.3% of presenting complaints. In addition, 22.9% of patients had genitourinary pain, 50.7% of patients required emergent urologic treatment, and 7.4% of patients presented with renal insufficiency or urethral abscess/necrotizing fasciitis directly related to urethral stricture.

CONCLUSION: Although many patients with urethral stricture present initially with LUTS or AUR, almost one quarter of patients have a different presenting complaint. Defining successful treatment of anterior urethral stricture should include more than improvement in LUTS or absence of urinary retention. Urethral stricture is not just a "quality of life" condition because >50% of patients require emergent treatment and 7.4% have a life-threatening condition directly related to the stricture.