Urethral Stricture and HIV: Unusual Presentations and Treatment Challenge

Objective: The clinico-pathologic features of urethral stricture in patients with HIV/AIDS are not yet clearly described in the literature. HIV/AIDS has changed the natural course and clinical features of most infectious diseases. We describe some of the features of post-inflammatory strictures associated with HIV Infection and assess the treatment challenges and outcomes of other causes of urethral stricture. Patients and Methods: Consecutive men with urethral stricture who presented to the University Hospital of Gondar; North-West Ethiopia were enrolled. The HIV status; cause of the stricture; type of treatment and outcome were recorded. Results: There were 25 post-traumatic and 15 post-gonococcal urethral strictures. All posttraumatic and 5 of the post-gonococcal urethral stricture patients were HIV negative. All 10 HIV positive patients had longer and denser urethral strictures than expected. The time between gonococcal infection and urethral stricture development was 3-5 years in HIV positive patients. The treatment of post-traumatic stricture included progressive perineal anastomotic urethroplasty and a good outcome was seen in more than 95. However; the surgical treatment of patients with HIV infection was a challenge. Conclusion: If post-inflammatory urethral stricture occurs in a young man where the time between known gonococcal infection and development of stricture is short (less than 5 years); HIV coinfection is most likely. The stricture in these patients will be longer and denser and not amenable to conventional endoscopic urethrotomy

Comparison of Prostatic Volume Measured with Abdominal Ultrasound and Prostatic Weight Determined after Open Enucleation Performed in Gondar University Hospital; Ethiopia

Objective: To describe the pathologic pattern of invasive bladder carcinoma in cystectomy specimens in relation to bilharziasis. Patients and Methods: Between April 2002 and October 2006; 148 consecutive patients with invasive bladder cancer were subjected to radical cystectomy and orthotopic sigmoid bladder substitution at Al-Azhar Urology Department; Cairo; Egypt. A retrospective computerized data- base analysis of the pathologic features of the cystectomy specimens was done focusing on the impact of bilharziasis on the pathology of bladder carcinoma. The tumor cell type; stage; grade and gross features in addition to lymph node involvement were particularly noted. Results: Bilharzial bladder pathology (lesions or ova) was present in 105 (70.9) of 148 cystectomy specimens. Tumor histology included transitional cell carcinoma (TCC) in 84 (56.7); squamous cell carcinoma (SCC) in 51 (34.5); adenocarcinoma in 9 (6.1) and anaplastic tumor in 4 (2.7) of these specimens. Most tumors associated with bilharziasis were bulky and appeared fungating or ulcerative. The pathologic tumor stage was pT2 in 23; pT3 in 70.9and pT4a involving the prostate or seminal vesicles in 6.1. None of these pT4a tumors were SCC. The tumor grade was described as low grade in 72 (48.6) and high grade in 76 (51.4) specimens. Regional lymph node involvement was detected in 31 (20.9) specimens irrespective of bilharzial infestation. Conclusion: Invasive bladder carcinoma associated with bilharzial pathology is mainly stage pT3; low-grade SCC and commonly appears as an ulcerative; bulky; fungating or verrucous mass. On the other hand; bladder carcinoma not associated with bilharziasis is mainly high-grade TCC and commonly appears as nodular or fungating lesions. Positive surgical margin and lymph node involvement are unrelated to bilharzial infestation