Endoscopic Balloon Dilation Under Fluoroscopic Guidance for the Treatment of Urethral Strictures in Chad: Initial Experience

Introduction: Male urethral stricture disease is a common condition in sub-Saharan Africa, associated with significant morbidity. Fluoroscopy-guided endoscopic balloon dilation, a minimally invasive technique that applies uniform radial force, has emerged as a promising alternative to conventional endoscopic approaches. However, data from African settings, particularly from Chad, remain limited. This study aimed to evaluate the feasibility and functional outcomes of this technique in our setting. Methods: We conducted a prospective, observational, and analytical study at the University Hospital Center La Renaissance in N’Djamena over an 18-month period (November 2024-October 2025). Thirty consecutive adult patients with a single, short urethral stricture were included. Balloon dilation was performed under fluoroscopic guidance. The primary endpoint was success, defined as the absence of clinical or endoscopic recurrence. Secondary endpoints included complications, time to recurrence, and the need for additional intervention. Results: The mean age of patients was 36.9 years, and the mean delay before consultation was 9 months. Symptoms were predominantly obstructive, mainly dysuria with reduced urinary flow. A suprapubic cystostomy was present in 20% of patients. Bulbar strictures were the most common location. The procedure was performed under spinal anesthesia in 97% of cases, with a mean operative time of 23 minutes. Significant clinical improvement was observed, including increased urinary flow and reduced post-void residual urine. At 6 months, the overall success rate was approximately 90%, with a recurrence rate of 10%. Two patients required repeat dilation. Conclusion: Fluoroscopy-guided endoscopic balloon dilation is a feasible, safe, and effective short-term treatment for short urethral strictures in Chad. It represents a valuable option in resource-limited settings, although studies with longer follow-up are needed to confirm its durability.