Holmium: YAG Versus Cold Knife Internal Urethrotomy in the Management of Short Urethral Strictures: A Randomized Controlled Trial Holmium Versus Cold Knife VIU
Journal of Lasers in Medical Sciences,
Vol. 12 (2021),
13 February 2021
,
Page e35
Abstract
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 effective surgical options 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.
- Holmium laser, Urethral stricture, Outflow obstruction, Internal urethrotomy, Uroflowmetry
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References
Torres Castellanos L, Moreno Bencardino MC, Bravo-Balado A, García Mayorga CA, Vargas Manrique I, Fernández N. Evaluation of the Efficacy and Safety of Laser versus Cold Knife Urethrotomy in the Management of Patients with Urethral Strictures: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Urol Int .
;99(4):453–9. DOI: 10.1159/000478026
Zhou S, Zhang J, Sa Y, Jin S, Xu Y, Fu Q, et al. Etiology and Management of Male Iatrogenic Urethral Stricture: Retrospective Analysis of 172 Cases in a Single Medical Center. Urol Int. 2016;97(4):386–91. DOI: 10.1159/000444592
Aboulela W, ElSheemy MS, Shoukry M, Shouman AM, Shoukry AI, Ghoneima W, et al. Visual internal urethrotomy for management of urethral strictures in boys: a comparison of short-term outcome of holmium laser versus cold knife. Int Urol Nephrol. 2018 Apr 3;50(4):605–9. DOI: 10.1007/s11255-018-1809-x
Mundy AR, Andrich DE. Urethral strictures. BJU Int. 2011 Jan;107(1):6–26. DOI: 10.1111/j.1464-410X.2010.09800.x
Higazy A, Tawfeek AM, Abdalla HM, Shorbagy A, Mousa W, Radwan AI. Holmium laser enucleation of the prostate versus bipolar transurethral enucleation of the prostate in management of benign prostatic hyperplasia: A randomized controlled trial. Int J Urol. 2020 Dec 16;iju.14462. DOI: 10.1111/iju.14462
Peterson AC, Webster GD. Management of urethral stricture disease: developing options for surgical intervention. BJU Int. 2004 Nov;94(7):971–6. DOI: 10.1111/j.1464- 410X.2004.05088.x
Singh B, Jain S, Kaza RC. Evaluation of holmium laser versus cold knife in optical internal urethrotomy for the management of short segment urethral stricture. Urol Ann. 2014;6(4):328. DOI: 10.4103/0974-7796.140997
Herrmann TRW, Liatsikos EN, Nagele U, Traxer O, Merseburger AS. EAU Guidelines on Laser Technologies. Eur Urol. 2012 Apr;61(4):783–95. DOI:10.1016/j.eururo.2012.01.010
Razzaghi MR, Karkan MF, Ghiasy S, Javanmard B. Laser application in Iran urology: A narrative review. J Lasers Med Sci. 2018;9(1):1–6. DOI: 10.15171/jlms.2018.01
Futao S, Wentong Z, Yan Z, Qingyu D, Aiwu L. Application of endoscopic Ho:YAG laser incision technique treating urethral strictures and urethral atresias in pediatric patients. Pediatr Surg Int. 2006 Jun 29;22(6):514–8. DOI: 10.1007/s00383-006-1692-x
C SA, Wroblewski M. Comparison of treatment results between holmium laser endourethrotomy and optical internal urethrotomy for urethral stricture. Int Urol Nephrol . 2012 Jun 30;44(3):717–24. DOI: 10.1007/s11255-011-0094-8
Sachse S. Meta analysis Safety and efficacy of laser and cold knife urethrotomy for. 2010;123(12):1589–95. DOI: 10.3760/cma.j.issn.0366-6999.2010.12.020
Barbagli G, De Stefani S, Sighinolfi MC, Pollastri CA, Annino F, Micali S, et al. Experience with fibrin glue in bulbar urethral reconstruction using dorsal buccal mucosa graft. Urology. 2006 Apr;67(4):830–2.
Andrich DE, Mundy AR. Urethral strictures and their surgical treatment. BJU Int [Internet]. 2001 Dec 24;86(5):571–80. DOI: 10.1046/j.1464-410x.2000.00878.x
MacDonald MF, Santucci RA. Review and treatment algorithm of open surgical techniques for management of urethral strictures. Urology. 2005 Jan;65(1):9–15. DOI: 10.1016/j.urology.2004.07.011
Lagerveld BW, Laguna MP, Debruyne FMJ, De La Rosette JJMCH. Holmium:YAG Laser for Treatment of Strictures of Vesicourethral Anastomosis after Radical Prostatectomy. J Endourol. 2005 May;19(4):497–501. DOI:
1016/j.urology.2004.07.011
Dogra PN, Nabi G. Neodymium-YAG Laser Core through Urethrotomy in Obliterative Posttraumatic Urethral Strictures after Failed Initial Urethroplasty. Urol Int. 2002;68(4):265–7. DOI: 10.1159/000058448
Yenice MG, Seker KG, Sam E, Colakoglu Y, Atar FA, Sahin S, et al. Comparison of cold- knife optical internal urethrotomy and holmium:yag laser internal urethrotomy in bulbar urethral strictures. Cent Eur J Urol. 2018;71:114–20. DOI: 10.5173/ceju.2017.1391
Atak M, Tokgöz H, Akduman B, Erol B, Dönmez İ, Hancı V, et al. Low-power holmium:YAG laser urethrotomy for urethral stricture disease: Comparison of outcomes with the cold-knife technique. Kaohsiung J Med Sci. 2011 Nov;27(11):503–7. DOI: 10.10a16/j.kjms.2011.06.013
Karkan MF, Razzaghi MR, Karami H, Ghiasy S, Tayyebiazar A, Javanmard B. Experience of 138 transurethral urethrotomy with holmium: YAG laser. J Lasers Med Sci. 2019;10(2):104–7. DOI: 10.15171/jlms.2019.17
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