Hypothesis / aims of study
Male urethral stricture is a common condition in urological practice. The traditional therapeutic methods, including urethral dilatation and cold knife urethrotomy. The one that is most appealing to urologists and patients is direct VIU, as it is a minimally invasive endoscopic procedure. The aim of this study is to compare the safety and efficacy of using Holmium:YAG laser and the cold knife in treatment of short segment bulbar urethral stricture .
Study design, materials and methods
A total of 60 patients were included in this rondom prospective contolled study from April 2017 to September 2019 using retrograde endoscopic Ho:YAG laser and cold knife. They were divided into two groups,group 1 included 30 patients(18cases with stricture length <1cm and 12 more than 1cm ), each patient was submitted to conventional or cold knife urethrotomy and group 2 included 30 patients(23cases with stricture length <1cm and 7 more than 1cm ), each patient was submitted to HO:YAG laser urethrotomy. Inclusion criteria included Fresh, short and single stricture. Exclusion criteria were, Long stricture segments more than 1.5 cm, Urethral stricture following pelvic fracture and rupture urethra, Recurrent cases after open urethroplasty or endoscopic dilatation or visual internal urethrotomy and complicated cases as those associated with diverticulum or multiple level strictures.The diagnosis of urethral stricture was based on clinical history (obstructive symptoms), uroflowmetry, and combined Antegrade and retrograde urethrography.
Interpretation of results
After 6 months, no recurrence occurred in 14 cases from 18 (77.8%) with less than 1 cm stricture length of direct VIU cases versus 18 cases from 23 (78.3%) with less than 1 cm stricture length of Laser VIU cases and this difference was not statistically significant (p=0.970). On the other side, no recurrence occurred in 5 cases from 12 (41.7%) with stricture more than 1 cm of direct VIU cases versus 3 cases from 7 (42.9%) with more than 1 cm stricture length of Laser VIU cases which either was not statistically significant (p=0.960).