Presented by: Kale Munien MBBS
QLD Health Toowoomba Hospital

Introduction

The Toowoomba Base Hospital, situated in a regional area west of Brisbane, Queensland, serves a wide geographical catchment area that extends beyond state borders. Many patients residing in these areas prefer receiving treatment within their local vicinity. Our specialised service, which focuses on the management of urethral stricture disease (USD), offers a distinctive and expanding centralised approach, deviating from the traditional practice found in tertiary hospitals. Our comprehensive five-year prospective study examines the variations in complexity, patient demographics, and outcomes within this service, drawing comparisons to international data.

Materials

Urinary function, quality of life, sexual function, and patient satisfaction were evaluated both before and after the surgery at multiple time points (one, three, six, and 12 months). A standardised technique for BMG urethroplasty, performed by a reconstructive urologist with fellowship training, was employed. Patient characteristics, geographical location, previous methods of managing strictures, and the complexity of the strictures were documented.

Results

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This study enrolled a total of 54 patients, with an average age of 57, BMI of 31, and ASA score of 2. The etiology of strictures in these patients was classified as inflammatory (1), idiopathic (25), iatrogenic (22), or traumatic (6). Prior management included multiple dilatations (maximum 40) and urethrotomies (maximum 4), with 33% of patients requiring clean intermittent self-catheterization (CISC). Eight patients underwent double-face urethroplasty. Among the patients, 19 had near-obliterative strictures and 7 had obliterative strictures. The patient located furthest geographically was 1353 km away, and eight patients were referred from metropolitan centers. The outcomes of the study were consistent with international data. The success rate of the initial procedure was 97%, which increased to 100% after redo urethroplasty.

Conclusion

This study provides evidence that centralising the management of urethral stricture disease (USD) in regional centres is a successful approach to overcome the challenges posed by Australia's extensive geographic area. Despite dealing with more complex strictures and various patient factors, the functional and operative outcomes achieved in this regional centre were comparable to international data. It should be noted that centralisation does not necessarily require a major city center, but rather a center that delivers suitable care. This model could be applied to other subspecialty procedures, offering improved healthcare accessibility while maintaining favorable patient outcomes.

Funding

No funding

Lead Authors

William Harrison, MBBS, B MSci
QLD Health

Co-Authors

Devang Desai, MBBS, FRACS
QLD Health