UROLOGICAL SURVEY
Reconstructive urology
Internal urethrotomy and intraurethral submucosal injection of triamcinolone in short bulbar urethral strictures
Mazdak H, Izadpanahi MH, Ghalamkari A, Kabiri M, Khorrami MH, Nouri-Mahdavi K, Alizadeh F, Zargham M, Tadayyon F, Mohammadi A, Yazdani M
Al-Zahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
Int Urol Nephrol. 2009 Dec 1. [Epub ahead of print]
OBJECTIVES: In clinical practice, internal urethrotomy is an easy procedure and is offered as a first modality for treatment of short urethral strictures. Internal urethrotomy refers to any procedure that opens the stricture by incising or ablating it transurethrally. The most common complication of internal urethrotomy is stricture recurrence. The curative success rate of internal urethrotomy is approximately 20%. Triamcinolone has antifibroblast and anticollagen properties. This study evaluated the efficacy of triamcinolone in the prevention of anterior urethral stricture recurrence after internal urethrotomy.
METHODS: Fifty male patients with anterior urethral stricture were randomized to undergo internal urethrotomy with or without urethral submucosal injection of triamcinolone. Using general anesthesia urethrotomy was performed. Triamcinolone (40 mg) was injected submucosally at the urethrotomy site in 25 patients. The patients were followed for at least 12 months and the stricture recurrence rate was compared between the two groups.
RESULTS: 23 patients in the triamcinolone group and 22 in the control group completed the study. There were no significant differences in the baseline characteristics of the patients or the etiology of the stricture between the two groups. Mean follow-up time was 13.7 +/- 5.5 months (range: 1-25 months). Urethral stricture recurred in five patients (21.7%) in the triamcinolone group and in 11 patients (50%) in the control group (P = 0.04).
CONCLUSIONS: Injection of triamcinolone significantly reduced stricture recurrence after internal urethrotomy. Further investigations are warranted to confirm its efficacy and safety.
Editorial Comment
There have been several efforts to increase the efficacy of internal urethrotomy using injection of agents designed to reduce scar formation. Among these, include steroids and botulinum toxin. As described by Wright et al, even a modest increase in the success rate of internal urethrotomy would translate into a much greater preference for urethrotomy over urethroplasty in cost-effectiveness models (1). The current article represents the first randomized trial of steroid injection at the time of internal urethrotomy. The initial results are encouraging. Follow-up was short and the mean time to stricture recurrence was longer in the steroid group. It is possible; therefore, that steroid injection only delays rather than reduces recurrence. Longer follow-up and repeat studies in other clinical settings are needed.
Dr. Sean P. Elliott
Department of Urology Surgery
University of Minnesota
Minneapolis, Minnesota, USA
E-mail: selliott@umn.edu
- 1. Wright JL, Wessells H, Nathens AB, Hollingworth W: What is the most cost-effective treatment for 1 to 2-cm bulbar urethral strictures: societal approach using decision analysis. Urology 2006, 67:889-93.
Publication Dates
-
Publication in this collection
07 Apr 2010 -
Date of issue
Feb 2010
