Low – Power Holmium: YAG Laser Visual Internal Urethrotomy For The Management of Urethral Stricture Disease In A Tertiary Government Hospital: A Descriptive Study

Tuazon R1, Tan K1

Research Type

Clinical

Abstract Category

Urethra Male / Female

Abstract 304
ePoster 5
Scientific Open Discussion Session 21
On-Demand
Surgery Quality of Life (QoL) New Instrumentation
1. Veterans Memorial Medical Center
Presenter
R

Ryan Josef Tuazon

Links

Abstract

Hypothesis / aims of study
To evaluate the role of urethral stricture treatment outcomes among patients in tertiary Government hospital.
Study design, materials and methods
The research was conducted at a Tertiary Government Hospital. The time frame was 2 years. Inclusion criteria includes the following: Male ages 18 years old and above, presence of obstructive symptoms, peak flow rate on uroflowmetry less than 15ml/s and short segment strictures  (Stricture length <1cm) as evident on radiologic studies. Exclusion criteria includes the following: Complete obliteration of lumen of urethra on urethroscopy, age less than 18 years old, multiple strictures, active urinary tract infection and recurrent strictures.

 The holmium laser fiber was introduced through a side channel once the stricture was visualized by urethroscopy. Operative time was recorded as the time interval beginning with insertion of optical urethrotome from external urethral meatus, continuing with procedure either by laser and ending with the removal of urethrotome from external urethral meatus. A 16-18 F silicone Foley catheter was inserted per urethra at the end of the procedure. 

 Spontaneous voiding with peak flow rate more than 15 ml/seconds without any requirement of post- operative urethral dilatation was taken as a successful procedure. At each follow up visit uroflowmetry was performed. If the peak flow rate on uroflowmetry dropped to less than 15/seconds, urethral dilatation was performed.
Results
A total of 28 male patients underwent Laser Visual Internal Urethrotomy from January 2017-December 2018. 

On Day 15 post operatively, Seventeen (17) Patients had Voided Volume of >200ml and Eleven (11) Patients had <200ml Voided Volume hence was advised for repeat Uroflowmetry. Eighteen (18) patients had Peak flow of >15ml/sec, and Ten (10) patients with <15ml/sec hence is advised for Urethral Calibration and Dilatation. On Day 30 post operatively, Twenty one(21) Patients had Voided Volume of >200ml and Six (6) Patients had <200ml Voided Volume hence was advised for repeat Uroflowmetry. Twenty (20) patients had Peakflow of >15ml/sec, and Seven (7) patients with <15ml/sec hence is advised for Urethral Calibration and Dilatation. On day 180 post operatively, Six (6) Patients had Voided Volume of >200ml and Four (4) Patients had <200ml Voided Volume hence was advised for repeat Uroflowmetry. Six (6) patients had Peakflow of >15ml/sec, and Four (4) patients with <15ml/sec hence is advised for Urethral Calibration and Dilatation
Interpretation of results
There is a highly statistically significant difference between the Residual Volume before and after treatment. The t value at 4.527 is found to be statistically significant at p value 0.000. This means that the amount of urine that remains after excretion has been substantially reduced. There is a highly statistically significant difference between the Peak Flow Rate before and after treatment. The t score at -7.333 is found to be highly significant at p value= 0.000. This indicates that the constriction of the passage way has been substantially decreased after treatment. Hence, giving the patient a favorable outcome and can perform spontaneous urination without problems.
Concluding message
The study showed that using the Holmium Laser Visual Internal Urethrotomy as a modality for the management of Urethral Stricture offers a significant advantage with its coagulation ability, improvement with the quality of life of the patient along with the improvement of the lower urinary tract symptoms.
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References
  1. Jain, Sudhir Kumar, Ram Chandra Murthy Kaza, and Bipin Kumar Singh. “Evaluation of Holmium Laser versus Cold Knife in Optical Internal Urethrotomy for the Management of Short Segment Urethral Stricture.” Urology Annals 6.4 (2014): 328–333. PMC. Web. 6 July 2017
  2. Jordan, G.H., Devine, P.C. Management of urethral stricture disease. Urol Clin North Am. 1988;15:277–289.
  3. Kamp, S., Knoll, T., Osman, M.M., Köhrmann, K.U., Michel, M.S., Alken, P. Low-power holmium: YAG laser urethrotomy for treatment of urethral strictures: functional outcome and quality of life.J Endourol. 2006;20:38–41.
Disclosures
Funding None Clinical Trial No Subjects Human Ethics Committee Institutional Review Board Helsinki Yes Informed Consent Yes
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