Holmium laser versus cold knife visual internal urethrotomy for management of short segment urethral stricture: a prospective randomized clinical trial (original) (raw)
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Urology Annals, 2014
Urethral stricture is one of the most difficult urological problems to cure adequately and is known to mankind since ages as it has been documented in ancient literature of the Hindus, [1] Egyptians and Greeks. [2] Different techniques have been employed for the treatment of urethral strictures, depending on the stricture length, location, and depth of scar [3,4] which include simple dilatation, urethrotomy, uroLume stent placement, [2,5] urethroplasty and perineal urethrostomy. [6] Optical internal urethrotomy (OIU) is one of the most commonly used procedures for urethral stricture. [7-9] Data from the National Health Service in the UK during 2006 showed that the OIU or urethral dilatation was used in 93% of cases and urethroplasty in 7% of cases. [10] Optical internal Objectives: Sachse cold knife is conventionally used for optical internal urethrotomy intended to manage urethral strictures and Ho: YAG laser is an alternative to it. The aim of this study was to evaluate the role of urethral stricture treatment outcomes, efficacy, and complications using cold knife and Ho: YAG (Holmium laser) for optical internal urethrotomy Materials and Methods: In this prospective study included, 90 male patients age >18 years, with diagnosis of urethral stricture admitted for internal optical urethrotomy during April 2010 to March 2012. The patients were randomized into two groups containing 45 patients each using computer generated random number. In group A (Holmium group), internal urethrotomy was done with Holmium laser and in group B (Cold knife group) Sachse cold knife was used. Patients were followed up for 6 months after surgery in Out Patient Department on 15, 30 and 180 post-operative days. At each follow up visit physical examination, and uroflowmetry was performed along with noting complaints, if any. Results: The peak flow rates (PFR) were compared between the two groups on each follow up. At 180 days (6 month interval) the difference between mean of PFR for Holmium and Cold knife group was statistically highly significant (P < 0.001). Complications were seen in 12.22% of cases. Conclusion: Both modalities are effective in providing immediate relief to patients with single and short segment (<2 cm long) urethral strictures but more sustained response was attained with Cold knife urethrotomy.
Central European journal of urology, 2018
To compare the results of cold-knife optical internal urethrotomy (OIU) and Holmium:YAG laser internal urethrotomy (HIU) in primary bulbar urethral strictures. A total of 63 patients diagnosed with primary bulbar urethral stricture between August 2014 and September 2015 were assigned to the OIU (n = 29) and HIU (n = 34) groups. The demographic variables, biochemistry panels, and preoperative and postoperative uroflowmetry results including the maximum flow rate (Qmax) and mean flow rate (Qmean) values, retrograde urethrography, and diagnostic flexible urethroscopy findings were recorded prospectively. Demographic features and preoperative values were not statistically different between groups (p >0.05). Mean surgical times were 18.4 ±2.3 min for OIU and 21.9 ±3.8 min for HIU groups, which was statistically significant (p <0.05). There was no significant difference in complication rates in both groups (p = 0.618). Postoperative Qmax values were increased in both groups even tho...
Scandinavian Journal of Urology, 2020
Aim: The study aimed to assess and compare urethral stricture (US) management outcomes, efficiency, and complications, treated by either Amplatz renal dilator or visual internal urethrotomy (VIU). Patients and methods: This prospective comparative study was carried out on 88 male patients with stricture urethra. All patients have performed a physical examination, ascending and micturition urethrography, urodynamic, and pelvic ultrasound. The patients were randomized divided into group 1 (Amplatz group) 44 patients treated with Amplatz dilator, and group 2 (VIU group) 44 patients treated with a cold knife. Patients were followed up at 15 days,3,6, and 12 months after the procedure. Result: The mean age was 41.2 (22-73) years. The mean stricture length in group 1 and group 2 was 1.01 ± 0.40 and 1.04 ± 0.30, respectively (p ¼ 0.421). The average IPSS score at baseline for group 1 and group 2 was 21.2 and 21.9 points, respectively. During the 12 months follow-up, IPSS improved, with average scores of 16.1 and 17.3 for group 1 and group 2, respectively (p > 0.05). The mean values of (Q max) between group 1 and group 2 at baseline, day 15, day 90 and 180 days showed no significant difference but at 12 months, (Q max) showed a higher significant difference in group 1 than group 2 (p ¼ 0.003). The post-void residual (PVR) displayed a significant decline in both groups from baseline. After 1 year, PVR showed that group 2 was a little higher than group 1 (no significance) compared to baseline The procedures were found effective without recurrence in all patients (both groups) during the 12 months (Q max > 15m/s). However, group 2 reported (11.4%) intra-operative bleeding, and (6.8%) extravasations. Conclusion: The guided urethral dilation and internal urethrotomy are safe, short time procedures, and offer satisfactory results with the advance to VIUD in Qmax at 12 months. No recurrence was documented in both groups after 12 months. VIU reported 18% intraoperative complication.
2017
Background: Sachse cold knife is conventionally used for optical internal urethrotomy to manage urethral strictures. In this procedure, the complications and recurrence rates are relatively high. We suggest combined electro cutter and cold knife as a success alternative in the management of intractable anterior urethral strictures. Methods: In this prospective study, 87 male patients aged ≥18 years, with diagnosed intractable urethral stricture (≥2 times recurrence) who were admitted for internal optical urethrotomy during May 2010 to Jun 2013, were included. The patients were randomized into two groups: group A (electro cutter - cold knife group, n= 45) and group B (cold knife group, n= 42). In group A, internal urethrotomy was done with electro cutter - cold knife, and in group B, Sachse cold knife was used. Patients were followed up for 6 months after surgery in Outpatient Department on 15, 30 and 180 post-operative days. Results: The success rates in group A and B were 46.6% (21...
The Role of Internal Optical Urethrotomy in the Management of Urethral Stricture
International Journal of Science and Research (IJSR)
Urethral stricture in the male still presents one of the most common and challenging problems to the urologist. Treatment options include dilation, endoscopic internal urethrotomy & urethroplasty, however optical internal urethrotomy offers faster recovery, minimal scarring, and less risk of infection. Aim of the study was to evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. A total of 75 male patients (16-25 years of age) having urethral strictures were treated with internal optical urethrotomy at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2013 and January 2016.Follow-up period ranged from 1-3 months. Outcome was graded as good, fair & poor. It was found that out of 75 patients, 28(37.3%) were between 21 and 30 years of age. The most common cause of stricture was trauma in 40 (53.3%) & the most common presenting complaint was poor urinary stream in 32(42.6%) patients while the most common site was bulbous urethra in 48 (64%) cases followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) cases showed minor post-operative bleeding with no major complications. We concluded that internal optical urethrotomy is a safe and effective procedure in treating urethral stricture.
Annals of International medical and Dental Research, 2017
Background: Direct visual internal urethrotomy (DVIU) and urethral dilatation are the most commonly performed procedures for urethral stricture disease. This approach is appealing both for urologists and patients as it is minimally invasive. The objective of this paper is to outline the current scientific evidence supporting this approach for its use in the management of urethral strictures in patients with multiple morbidities who would not tolerate prolonged surgeries well and to share our own experiences. Methods: We performed a retrospective study of cystoscopy-guided internal urethrotomies performed between 2009 and 2014 on patients with co morbid conditions. Results: Overall, urethral stricture stabilized in 76.7% of patients with 1 or 2 internal urethrotomies within 24 months of follow-up.Conclusion: Direct vision cold knife urethrotomy is a safe technique that should be exercised as a therapeutic trial in patients with co morbidities as an alternative giving a safer and easier option.
Bangladesh Journal of Urology, 2020
Objective: This study was conducted to compare the outcome of anastomotic urethroplasty with that of traditional optical internal urethrotomy in the treatment of short-segment bulbar urethral stricture. Methods: This comparative clinical study was conducted in the Department of Urology, Dhaka Medical College Hospital over a period 1 year from January 2007 to December 2008. A total of 50 patients with short-segment (< 2 cm) bulbar urethral strictures were consecutively included in the study. The test statistics used to analyses the data were Fisher’s Exact Probability Test, Student’s t-Test. For all analytical tests, the level of significance was set at 0.05 and p < 0.05 was considered significant. Results: About one-quarter (24%) of patients in OI Urethrotomy group experienced bleeding, 4% epididymitis and another 4% incontinence. In contrast, 8% of patients in Anastomotic Urethroplasty group complained of periurethral leakage, 8% fever and another 8% wound infection. Apart fr...
The Role of Internal Optical Urethrotomy in the Treatment of Male Urethral Stricture
Open Journal of Urology, 2018
Background: Male urethral stricture is as yet considered one of the very popular and defying dilemmas to the urologist. Treatment modalities include dilation, endoscopic urethrotomy and urethroplasty, however internal optical urethrotomy displays rapid cure, lower scarring, and minimal hazard of infection. Purpose: To evaluate the efficacy of internal optical urethrotomy in the treatment of patients with urethral stricture. Patients & Methods: This study was carried out at Al-Yermouk Teaching Hospital/Baghdad/Iraq in the period between January 2015 and January 2018. A group of 75 male patients (16-25 years of age) presented with urethral strictures had been treated with internal optical urethrotomy. Follow-up period ranged from 1-3 months. Outcome was graded as good, fair and poor. Results: Out of 75 patients, 28 (37.3%) were (21-30) years of age. Trauma was the most popular source of stricture found in 40 (53.3%) and the most widespread presenting feature was poor urinary flow in 32 (42.6%) patients. Stricture in the bulbous urethra in 48 (64%) cases was found to be the most prevalent area followed by penile urethra in 16 (21.3%) cases. Overall response rate was good in 52 (69.3%) patients. Eleven (14.6%) patients exhibited only minor bleeding postoperatively with no other considerable complications. Conclusion: Internal optical urethrotomy is a dependable and effective procedure in treating urethral stricture.
Central European journal of urology, 2015
To study the efficacy of holmium laser urethrotomy with intralesional injection of Santosh PGI tetra-inject (Triamcinolone, Mitomycin C, Hyaluronidase and N-acetyl cysteine) in the treatment of urethral strictures. A total of 50 patients with symptomatic urethral stricture were evaluated by clinical history, physical examination, uroflowmetry and retrograde urethrogram preoperatively. All patients were treated with holmium laser urethrotomy, followed by injection of tetra-inject at the urethrotomy site. Tetra-inject was prepared by diluting acombination of 40 mg Triamcinolone, 2 mg Mitomycin, 3000 UHyaluronidase and 600 mg N-acetyl cysteine in 5-10 ml of saline, according to the stricture length. An indwelling 18 Fr silicone catheter was left in place for 7-10 days.All patients were followed-up for 6-18 months postoperatively by history, uroflowmetry, and if required, retrograde urethrogram and micturating urethrogram every 3 months. 41 (82%) patients had asuccessful outcome,whereas...
The Journal of Urology, 1999
Purpose: We studied the safety and efficacy of core through urethrotomy with the neodymium (Nd):YAG laser for posttraumatic obliterative strictures of the bulbomembranous urethra. Materials and Methods: Eight patients a mean of 27.5 years old with posttraumatic (motor vehicle accidents) obliterative strictures of the bulbomembranous urethra were treated from May to December 1997. Laser treatment selection criteria were stricture length 2.0 cm. or less, good alignment between the urethral ends and no history of rectal injury or erectile dysfunction. All patients underwent core through urethrotomy with the Nd:YAG contact laser delivered with the 600 I*. bare fiber a t 15 to 25 W. The urethrotomy was guided only by a metal sound introduced through the suprapubic tract. Results: Blood loss was negligible and excellent visualization was maintained throughout the procedure. Operating time ranged from 45 to 70 minutes. There were no perioperative complications. Hospital stay was 24 hours in the first case and 6 to 8 hours in subsequent cases. All patients returned to work within 5 days. Urethroscopy was performed 4 and 12 weeks after catheter removal in all patients. Only 1 patient required repeat internal urethrotomy. Voidmg cystourethrography revealed a stricture-free urethra in 7 cases. At last followup 7 to 14 months (mean 10.25) after the procedure mean maximum flow rate was 18.6 ml. per second (range 16.5 to 22.4) in the patients who were stricture-free and 11.8 ml. per second in 1 with recurrent stricture. Conclusions: Core through urethrotomy with the contact Nd:YAG laser seems to be a safe and effective treatment option for select strictures. The hospital stay is remarkably short and complications are negligible. &-stricture rates are likely to be low but more experience and longer followup are needed.