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RECONSTRUCTIVE
UROLOGY
doi: 10.1590/S1677-553820100001000028
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.
References
- 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.
Dr.
Sean P. Elliott
Department of Urology Surgery
University of Minnesota
Minneapolis, Minnesota, USA
E-mail: selliott@umn.edu
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