Efficacy of holmium laser urethrotomy in combination with intralesional steroids in the treatment of bulbar urethral stricture: A randomized controlled trial

Amin, Mahmoud; Shorbagy, Ahmed A.; Abdalla, Hany M.; Shoeb, Mohamed; Mousa, Waleed

doi:10.4103/ejs.ejs_82_22

Efficacy of holmium laser urethrotomy in combination with intralesional steroids in the treatment of bulbar urethral stricture: A randomized controlled trial

Authors

Abstract

Introduction
The aim was to evaluate the efficacy of holmium: YAG laser urethrotomy along with intralesional triamcinolone injection in decreasing the incidence of recurrence in the management of primary bulbar urethral stricture.
Materials and methods
A total of 124 male patients with primary short (<1.5) fresh bulbar urethral stricture disease were included in our study from 2020 to 2021. Patients were allocated randomly into two equal groups. Group A included those who underwent laser internal urethrotomy only and group B included those who underwent laser internal urethrotomy followed by injection of triamcinolone at the site of urethrotomy. A careful evaluation with uroflowmetry and ascending urethrography was preoperatively. All patients were evaluated with uroflowmetry at 3 and 6 months, and retrograde urethrography was performed if needed.
Results
Each group included 60 patients. The results showed a success rate of 70 and 90% in groups A and B, respectively. In group A, eight cases (13.3%) had recurrence at the third month, whereas in group B, there was no recurrence, with a success rate of 100%. At the sixth month, 10 cases (16.7%) had recurrence in group A, whereas six cases (10%) in group B had recurrence. So, total recurrence in group A was 18 cases (30%) and in group B was six cases (10%), which was statistically different (=0.006). In our study, we observed that the time of recurrence of urethral stricture in steroid-treated group was delayed to 6 months in comparison with nonsteroid-treated group. No major intraoperative or postoperative complications occurred. All complications were mild and managed conservatively. The difference was not statistically significant between both groups.
Conclusions
Intraurethral corticosteroid injection at the stricture site following holmium laser urethrotomy seems to be a safe and effective modality of treatment in decreasing the rate of stricture recurrence.

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