Kenya’s manhood in jeopardy

Doctors are warning that injuries and trauma have overtaken infections as the major cause of trouble in the male reproductive system.

Specifically, they are worried about urethral strictures or scarring of the urinary canal which can lead to a narrowing of the tube with devastating results. If left untreated, this can cause serious problems, including bladder and kidney damage, infections caused by the obstruction of urine flow, and poor ejaculation and infertility in men.

Violent injuries and trauma

Traditionally the blockage of this crucial tube has been associated with advancing age or sexually transmitted diseases especially gonorrhoea.

But this has changed; doctors say it is increasingly affecting younger people and largely caused by violent injuries or trauma.

A review of cases of urethral strictures at Moi Referral and Teaching Hospital (MRTH), published in July, confirms the unsettling trend.

The review involved 65 male patients admitted with and operated on for urethral strictures at the hospital’s urology clinic. This is the clinic dealing with medical diseases of the male and female urinary-tract system and the male reproductive organs.

In more than a third of the patients, 35.4 per cent of the scarring had been caused by injuries, 24.6 per cent due to sexually transmitted diseases, 23 per cent from unknown causes and 19 per cent from hospital-related procedures.

“There is a change in the pattern of the cause of urethral strictures at the hospital from infections to injuries,” says Pius Musau, a consultant urologist at MRTH.

Over time, the number of patients with urethral strictures has also overtaken those with the prostate disease at the MRTH clinic.

A decade ago, Dr Musau had reviewed 420 patients at the hospital’s urology unit reporting prostate disease as the major reason for males visiting the clinic.

However, by 2013, the top three urological problems at the clinic were urethral strictures, prostate diseases and urinary tract infections in that order.

“The clinical burden of urethral strictures has overtaken that of prostate diseases in this tertiary centre,” Dr Musau wrote in the East African Medical Journal.

The same trend has been recently reported in other hospitals. Last year, Winston Makanga reported a similar trend at St Mary’s Mission Hospital.

Dr Makanga had reviewed the treatment of 29 male patients with urethral strictures reporting injuries and infections to equally share the blame.

“The finding of an equal number of trauma and inflammatory strictures was surprising,” said Makanga.

The surprise, he had explained, was because they had expected sexually transmitted diseases to be the undisputed cause of urethral strictures at the hospital.

Four months ago, in April, an expert team of urologist at Kenyatta National Hospital (KNH) expressed similar concerns after reviewing 235 patients treated for urethral strictures at the facility.

“Trauma was the leading cause of urethral strictures in the patients treated at the hospital,” reported Willy Otele, Sammy Miima, Francis Owilla and Simeon Monda.

The cause of the trauma, the say, was mainly from traffic accidents, assault, falls from a height and straddle injury among motor cyclists.

Three years ago, Edward Mugalo with colleagues at Moi University, Eldoret, reported high rates of impotence or erectile dysfunction (ED) among bicycle and boda boda riders in Eldoret.

The team had compared 173 riders with 179 non-riders and reported high rates of ED; 76 per cent among riders compared to only a third among the non-riders.

Complaints among riders included genital pain, irritation and numbness and problems in maintaining an erection. At the highest risk were riders using less padded bicycle saddles.

“Saddles with a wide base distribute pressure away from the genital area, while narrow nosed saddles exert undue pressure on the blood vessels,” explained Mugalo.

Doctors, it emerges, agree the cause of urethral strictures is changing from infections to trauma while assault, mainly among a younger male population, is of central concern.

For example, the Ministry of Health data shows injuries are the cause of one in 10 fatalities in Nairobi County.

“Undoubtedly, 10 per cent is alarmingly high especially because those involved are in the most productive age bracket,” says Gladwell Gathecha, a senior official at the ministry’s division of non-communicable diseases.

In Nairobi, Gathecha says men account for 85 per cent of all injuries which mainly involve the 25-44-year age group followed by those in the ages of 20–24.

Her report shows the main cause of injuries among the males is blunt force, followed by road traffic incident and then firearms.

The health ministry blames the high rate of violence among males partially to alcohol consumption and substance use.

But the blame is also laid on what the Gathecha team says is a sense of toxic masculinity that drives men to take unnecessary risks.

To address the problem, the Ministry of Health launched the Kenya National Violence and Injury Prevention and Control Action Plan 2018–2022 two years ago.

“Through this plan, we target reducing violence and injuries by 20 per cent within five years,” said Julius Korir, former Principal Secretary for Health, while launching the action plan.