scholarly journals Holmium laser vs. conventional (cold knife) direct visual internal urethrotomy for short-segment bulbar urethral stricture: Outcome analysis

2016 ◽  
Vol 10 (5-6) ◽  
pp. 161 ◽  
Author(s):  
Ankur Jhanwar ◽  
Manoj Kumar ◽  
Satya Narayan Sankhwar ◽  
Gaurav Prakash
Keyword(s):  
Urethral Stricture ◽  
Operating Time ◽  
Holmium Laser ◽  
Outcome Analysis ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
Urethral Strictures ◽  
Group A ◽  
Cold Knife ◽  
Group B

Introduction: Our goal was to analyze the outcome between holmium laser and cold knife direct visual internal urethrotomy (DVIU) for short-segment bulbar urethral stricture.Methods: We conducted a prospective study comprised of 112 male patients seen from June 2013 to December 2014. Inclusion criterion was short-segment bulbar urethral stricture (≤1.5cm). Exclusion criteria were prior intervention/urethroplasty, pan-anterior urethral strictures, posterior stenosis, urinary tract infection, and those who lost to followup. Patients were divided into two groups; Group A (n=58) included cold knife DVIU and group B (n=54) included holmium laser endourethrotomy patients. Patient followup included uroflowmetry at postoperative Day 3, as well as at three months and six months.Results: Baseline demographics were comparable in both groups. A total of 107 patients met the inclusion criteria and five patients were excluded due to inadequate followup. Mean stricture length was 1.31 ± 0.252 cm (p=0.53) and 1.34 ± 0.251 cm in Groups A and B, respectively. Mean operating time in Group A was 16.3 ± 1.78 min and in Group B was 20.96 ± 2.23 min (p=0.0001). Five patients in Group A had bleeding after the procedure that was managed conservatively by applying perineal compression. Three patients in Group B had fluid extravasation postoperatively. Qmax (ml/s) was found to be statistically insignificant between the two groups at all followups.Conclusions: Both holmium laser and cold knife urethrotomy are safe and equally effective in treating short-segment bulbar urethral strictures in terms of outcome and complication rate. However, holmium laser requires more expertise and is a costly alternative.

scholarly journals Holmium: YAG Versus Cold Knife Internal Urethrotomy in the Management of Short Urethral Strictures: A Randomized Controlled Trial

2021 ◽  
Vol 12 (1) ◽  
pp. e35-e35
Author(s):  
Mohamed A. Gamal ◽  
Ahmed Higazy ◽  
Samuel F. Ebskharoun ◽  
Ahmed Radwan
Keyword(s):  
Urethral Stricture ◽  
Controlled Trial ◽  
Demographic Data ◽  
Holmium Laser ◽  
Success Rates ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Significant Difference ◽  
Cold Knife ◽  
Male Patients

Introduction: our study aimed to assess the safety and efficacy of Holmium: YAG laser internal urethrotomy compared to the cold knife internal urethrotomy. Methods: Eighty adult male patients presented with a urethral stricture less than 1.5 cm were included in our study; they were randomly allocated into 2 groups representing Holmium and cold knife internal urethrotomy. A careful evaluation with ascending cystourethrogram and uroflowmetry were done on all patients, and they were followed up for 1 year with uroflowmetry. Results: Each group included 40 patients sharing the same demographic data. The most common cause of a urethral stricture in both groups was iatrogenic injury. The mean operative time of the cold knife urethrotomy procedure was 10.98 ± 2.40 minutes compared to 15.43 ± 2.48 minutes in the holmium laser urethrotomy group with a highly significant difference. The results showed success rates of 90% and 80% for the holmium laser and cold knife internal urethrotomy groups respectively. The perioperative complication according to the Clavien-Dindo classification, showed no statistically significant difference in grade 1 and 2 complications. A recurrence rate with the need for redo surgery representing grade 3B complication was seen in 4 cases in the Holmium group compared to 8 cases in the cold knife group with a statistically significant difference. Conclusion: Both Holmium Laser and cold knife internal urethrotomy are an effective surgical option for the treatment of a urethral stricture less than 1.5 cm with a promising outcome after 1-year follow-up with a better success rate using the Holmium laser.

scholarly journals Outcome Between Intralesional Injection of Triamcinolone following Optical Internal Urethrotomy (OIU) and OIU Alone for the Management of Short Segment Stricture of male Urethra

2021 ◽  
Vol 29 (2) ◽  
pp. 126-130
Author(s):  
Md Sazzad Hossain ◽  
Mir Ehteshamul Haque ◽  
Mohammad Zahid Hasan ◽  
Prodyut Kumar Saha ◽  
Mostafiger Rahman ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Statistical Tests ◽  
Time Interval ◽  
Intralesional Injection ◽  
Internal Urethrotomy ◽  
Short Segment ◽  
Quasi Experimental ◽  
Group A ◽  
Group B ◽  
Optical Internal Urethrotomy

Objective: To compare the outcome of optical internal urethrotomy (OIU) with or without intralesional triamcinolone acetonide injection for the treatment of short segment anterior urethral stricture. Methods: This prospective quasi experimental study was carried out in the department of Urology, DMCH, Dhaka from November 2015 to April 2017 on 50 patients with short segment of anterior urethral stricture. Cases were randomly allocated to group A (OIU without Triamcinolone) and group B (OIU with Triamcinolone). Each group consisted of 25 patients. Data were analyzed and compared by statistical tests. Results: There were no significant differences in the baseline characteristics of the patients. Recurrences of stricture urethra were higher among those without Triamcinolone than cases with Triamcinolone which was statistically significant (p=0.033) at 6 month and (p=0.016) at 9 months. Regarding mean time interval in month of development of recurrence of stricture was 6.1±1.66 months in Group A and 7.66±1.52 months in Group B which was statistically significant (p=0.001) Conclusion: OIU with intralesional triamcinolone is better than OIU alone. It significantly reduced and delayed the recurrence of anterior urethral stricture. J Dhaka Medical College, Vol. 29, No.2, October, 2020, Page 126-130

scholarly journals Sachse Laser in post-trauma urethral stricture. A valid alternative before urethroplasty.

2018 ◽  
Vol 2 (2) ◽  
Author(s):  
Astrit Mustafa ◽  
Evisa Zhapa ◽  
Francesco Saverio Grossi
Keyword(s):  
Urethral Stricture ◽  
Holmium Laser ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Before And After ◽  
Cold Knife ◽  
Multiple Treatments ◽  
Voided Volume

Background: The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy method according Sachse cold knife, but with low long-term success rate. Alternative method after failure is isurethroplasty with preputial flap or Buccal mucosa. The aim of this presentation is to report the efficacy of the Internal Urethrotomy with Holmium Laser (Sachse laser).Material and methods: We report three cases of urethral stenosis after trauma which treated with Internal Urethrotomy with Holmium Laser (Sachse laser) after failure of multiple treatments with Sachse cold knife. We evaluated and compared the uroflowmetry parameters before and after Sachse laser.Results: The average of uroflowmetry parameters before incision were: Q max 4.5 ml/sec, Q med 3 ml/sec. Voided Volume 323 cc, while after incision with Sachse laser were: Q max 30 ml/sec, Q med 12 ml/sec. Voided Volume 363 cc.No patients relapsed during follow-up time from 3 to 24 months.Conclusion: Even though these are only a few cases, we think that Sachse laser is a valid alternative after unsuccessful Sachse cold knife and before Urethroplasty, even in patients with urethral stricture after trauma.

scholarly journals Internal urethrotomy versus plasmakinetic energy for surgical treatment of urethral stricture

2015 ◽  
Vol 87 (2) ◽  
pp. 161 ◽  
Author(s):  
Levent Ozcan ◽  
Emre Can Polat ◽  
Alper Otunctemur ◽  
Efe Onen ◽  
Oğuz Ozden Cebeci ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Urethral Stricture ◽  
Maximum Flow ◽  
Clinical History ◽  
Internal Urethrotomy ◽  
Urethral Strictures ◽  
Cold Knife ◽  
Group 2 ◽  
Stricture Recurrence ◽  
Group 1

Purpose: we aimed to compare the longterm outcome of surgical treatment of urethral stricture with the internal urethrotomy and plasmakinetic energy. Material and Methods: 60 patients, who have been operated due to urethral stricture were enrolled in our clinic. None of the patients had a medical history of urethral stricture. The urethral strictures were diagnosed by clinical history, uroflowmetry, ultrasonography and urethrography. The patients were divided two groups. Group 1 consisted of 30 patients treated with plasmakinetic urethrotomy and group 2 comprised 30 men treated with cold knife urethrotomy. Results: There were no statistically significant differences between two groups in terms of patient age, maximum flow rate (Qmax) and quality of life score (Qol) value. A statistical difference between the two groups was observed when we compared the 3rd-month uroflowmetry results. Group 1 patients had a mean postoperative Qmax value of 16,1 ± 2,3 ml/s, whereas group 2 had a mean postoperative Qmax value of 15,1 ± 2,2 ml/s (p < 0.05). In the cold knife group, 3 of 11 (27,7%) recurrences appeared within the first 3 months, whereas in the plasmakinetic group zero recurrences appeared within the first 3 months in our study. The urethral stricture recurrence rate up to the 12 month period was statistically significant for group 1 (n = 7, 23%) compared with group 2 (n = 11, 37%) (p < 0.05). Conclusion: We believe that plasmakinetic surgery is better method than the cold knife technique for the treatment of urethral stricture.

scholarly journals Effect of preoperative urethral dilatation on preventing urethral stricture after holmium laser enucleation of the prostate: A randomized controlled study

2018 ◽  
Vol 13 (11) ◽  
Author(s):  
Jong Kwan Park ◽  
Ji Yong Kim ◽  
Jae Hyung You ◽  
Bo Ram Choi ◽  
Sung Chul Kam ◽  
...  
Keyword(s):  
Urethral Stricture ◽  
Holmium Laser ◽  
Controlled Study ◽  
Urethral Dilatation ◽  
Significant Difference ◽  
Group A ◽  
Laser Enucleation ◽  
Group B ◽  
Transurethral Prostate Surgery ◽  
Holmium Laser Enucleation

Introduction: We aimed to evaluate the effect of preoperative urethral dilatation during holmium laser enucleation of the prostate (HoLEP) on the prevention of urethral stricture. Methods: A total of 72 patients without urethral stricture underwent HoLEP for benign prostatic hyperplasia (BPH). Recruited patients were randomly divided into two groups (groups A and B). Patients in group A (36 patients, experimental group) received preoperative urethral dilatation and patients in group B (36 patients, control group) did not. Each patient was evaluated at four weeks, 12 weeks, and 24 weeks after surgery. The effectiveness of preoperative urethral dilatation was evaluated based on the International Prostate Symptom Score (IPSS), peak urine flow rate (Qmax), voided volume, and post-void residual (PVR) volume. To diagnose urethral stricture, Qmax <10 mL/s, as assessed using uroflowmetry and findings of visualization through retrograde urethrography and urethroscopy, were used. Results: Among 72 initial participants, 33 patients in group A and 31 patients in group B completed the experiment. Preoperative characteristics were well-balanced between groups. At each postoperative visit, there was no significant difference in voiding symptoms between groups. Two patients (6.06%) in group A and five patients (15.15%) in group B showed a Qmax <10 mL/s on uroflowmetry (p=0.013). On urethroscopy, no patient in group A (0%) and two patients in group B (6.45%) (p=0.021) showed urethral stricture after HoLEP. Conclusions: Preoperative urethral dilatation during HoLEP decreased the incidence of urethral stricture. This procedure could be useful to reduce the risk of urethral stricture after transurethral prostate surgery. One limitation of the current study is the single-centre design. Also, we sought to determine the efficacy of preoperative urethral dilatation for the prevention of urethral stricture after transurethral prostate surgery within a short time period, which could be another limitation of the study. Despite these limitations, to the best of our knowledge, the present study is the first reported prospective, randomized trial analyzing the safety and efficacy of preoperative urethral dilatation for the prevention of urethral stricture after transurethral prostate surgery.

Evaluation of Holmium Laser versus Cold Knife in Optical Internal Urethrotomy for the Management of Urethral Stricture

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Wael Ali Maged ◽  
Mohamed Ahmed Gamal ◽  
Samuel Fayek Tawfeles
Keyword(s):  
Urethral Stricture ◽  
Treatment Effectiveness ◽  
Holmium Laser ◽  
Military Hospital ◽  
University Hospitals ◽  
Internal Urethrotomy ◽  
Cold Knife ◽  
Group 10 ◽  
Optical Internal Urethrotomy

Abstract Background : urethral stricture is one of the most difficult urological problems to cure adequately and is know to mankind since ages as it has been documented in ancient literature of Egyptians and Greeks. Aim of the work: the aim of our study is to evaluate and compare the outcomes of Ho:YAG laser urethrotomy with the conventional cold knife technique as regards treatment outcome, efficacy and complications Patients and methods: A total of 20 male patients presented to the urology department at El Maadi military hospital and Ain shams university hospitals diagnosed as urethral stricture requiring optical internal urethrotomy were included in this study. Patients were randomized into two groups : In group A (holmium group): 10 patients underwent internal urethrotomy with Holmium laser. In group B (cold knife group) 10 patients underwent internal urethrotomy with cold knife. Results: based upon uroflowmetry, assessment of treatment effectiveness and complications were made at 3 months follow-up. Post operative fall in the peak flow rate was noted during the follow up in both groups, but was highter fall in the holmium group than the cold knife group at the end of the third month.

scholarly journals Treatment of Short Segment Anterior Urethral Stricture: Optical Internal Urethrotomy (OIU) Alone and OIU with Triamcinolone

2019 ◽  
Vol 48 (1) ◽  
pp. 31-38
Author(s):  
Mohammad Humayun Kabir Bhuiyun ◽  
Abu Masud Al Mamun ◽  
Towhid Belal ◽  
Rezawanul Haque Rabbani ◽  
Md Khairul Islam ◽  
...  
Keyword(s):  
Triamcinolone Acetonide ◽  
Urethral Stricture ◽  
Therapeutic Modality ◽  
Control Group ◽  
Internal Urethrotomy ◽  
Triamcinolone Injection ◽  
Group A ◽  
Group B ◽  
Optical Internal Urethrotomy

Optical urethrotomy has been considered standard therapy for anterior urethral stricture since its introduction in 1976. Now optical internal urethrotomy (OIU) with intralesional triamcinolone injection is a safe and effective, minimally invasive therapeutic modality. The aim of the study is to compare the outcome of OIU alone and OIU with intralesional triamcinolone injection in the treatment of anterior urethral stricture. This Quasi Experimental study was carried out among 50 male patients with bulbar urethral stricture in the Department of Urology, Dhaka Medical College Hospital, Dhaka, over a period of six months. The age range of the patients were 32-46 years and patients were divided equally into two groups, OIU with and without intralesional triamcinolone acetonide injection as Group- A (experimental group, 25 patients) and Group- B (control group, 25 patients). Post-operative evaluation was done on the basis of history and uroflowmetry. Retrograde urethrography and micturating cystourethrography were done only in patient who developed obstructive voiding problems or flow rate below 10 ml/second. Follow up was done at regular interval on 7th day, 3rd month and 6th month. Post-operative outcomes were compared between two groups. Post-operative infection was significantly higher among those OIU with intralesional Triamcinolone acetonide injection (8%) than patients without intralesional Triamcinolone acetonide injection (4%). Per operative extravasations of urine were significantly higher among those without intralesional Triamcinolone acetonide injection (4%) than subjects with intralesional Triamcinolone acetonide injection. Extravasation not influenced by steroid but this patient subsequently suffered recurrence of stricture. In Group-A, pre and post-operative Q-max were 10.25±2.21 and 22.11±2.96 ml/sec respectively. In Group-B, pre and post-operative follow up Q-max were 10.37±2.55 and 19.54±2.65 mi/sec respectively. In Group-A, pre and post-operative voiding time was 85.20±4.20 and 27.10±3.36 sec respectively. In Group-B, pre and post-operative follow up voiding time were 86.37±4.55 and 31.45±2.55 sec respectively. Post-operative recurrences of stricture were significantly higher among those without intralesional Triamcinolone acetonide injection (24%) than subjects with intralesional Triamcinolone acetonide injection (12%). Post-operative it seems that triamcinolone injection after OIU is safe method to prevent the recurrence of urethral stricture Bangladesh Med J. 2019 Jan; 48 (1): 31-38

Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife

2018 ◽  
Vol 50 (4) ◽  
pp. 605-609 ◽  
Author(s):  
Waseem Aboulela ◽  
Mohammed S. ElSheemy ◽  
Mahmoud Shoukry ◽  
Ahmed M. Shouman ◽  
Ahmed I. Shoukry ◽  
...  
Keyword(s):  
Holmium Laser ◽  
Internal Urethrotomy ◽  
Short Term ◽  
Term Outcome ◽  
Urethral Strictures ◽  
Short Term Outcome ◽  
Cold Knife
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