Comparison of Two Maneuvers of Local Steroid Usage After Optical Urethrotomy With Optical Urethrotomy Alone For Treatment of Bulbar Urethral Stricture

Abstract

Background: Male urethral strictures are challenging and complex problems in urological practice. It may lead to serious complications and disastrous consequences in the renal system. It is characterised by its high recurrence rates after intervention. Objectives: Our aim was to study and analyse the outcomes of two auxiliary techniques of local steroid usage (local installation of ointment in the urethra during CIC and needle injection inside the stricture) after optical urethrotomy to reduce the recurrence rate of bulbar urethral stricture and delay the time to recurrence and compare them with optical urethrotomy alone. Methods: A prospective comparative study was conducted between September 2019 and Oct 2023 and included a total of 64 male patients aged 18-60 years, who were recently diagnosed with bulbar urethral stricture of up to 20 mm involving the bulbar urethra. Idiopathic, inflammatory, and traumatic strictures were included. Our cases were sub-grouped into three main groups (group A, 22 cases; group B, 15 cases; and group C, 27 cases). All groups underwent cold knife optical urethrotomy; a triamcinolone intralesional injection was done in Group A, and self-CIC using intraurethral triamcinolone ointment (for a minimum duration of 6 months) was done in Group B. These patients were reevaluated and followed up clinically for 24 months. Flexible urethroscopy and/or retrograde urethrogram 6-monthly for all patients during the first year, selectively thereafter if there were obstructive voiding symptoms or difficulties in CIC. Results: A significant reduction in the re-stricture rate was reported in group A in comparison to groups B and C (18.2 vs 26% and 44% in sequence) (P<0.05). The average time to recurrence was also objectively much longer in the therapeutic group than in the control one (10.4 months and 9.5 months vs 6.5 months, respectively) (P<0.0001). The Qmax was obviously higher in the triamcinolone groups (17.5 ± 4.4 ml/second and 15.1 ± 4.7), compared to the control (12.2 ± 4.2 ml/second), which was statistically significant. The age of patients with recurrence was significantly older in the therapeutic groups than in the control group (42.5 years vs 38.6 years vs 33.5 years, respectively). The mean stricture length was objectively longer in triamcinolone groups (16.7 mm and 13.9 mm vs 12.9 mm, respectively) in patients with recurrence (P < 0.0001). Conclusion: Intralesional steroid injection and steroid installation during CIC were superior to native optical urethrotomy in decreasing urethral stricture recurrence after two years of follow-up, with minimal additional complications. Steroid injection techniques carry the highest success rate over urethral steroid dilation.