The effectiveness of local steroid injection after internal urethrotomy to avoid recurrence

Yıldırım, Mehmet; Kaynar, Mehmet; Özyuvalı, Ekrem; Badem, Hüseyin; Çakmak, Muzaffer; Kösem, Bahadır; Çimentepe, Ersin

doi:10.4081/aiua.2015.4.295

Cited by 19 publications

(18 citation statements)

References 25 publications

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“…In patients administered with simultaneous mitomycinc, promising results were demonstrated in the early period, and 75 % of the patients did not require additional intervention for 2 years (7). In another randomized study, methylprednisolone was used and a 95% success rate was observed in the 18-month follow-up (13). In their study, Kumar et al determined a success rate of 95.8% in a 12-month follow-up in laser urethrotomy in strictures less than 1 cm along with quadruplet injection (mitomycin-c, hyaluronidase, triamcinolone, n-acetylcysteine) (14).…”

Section: Discussionmentioning

confidence: 98%

Üretra darlığında endoskopik cerrahi; Bıçağa karşı lazer

Solakhan¹,

Bayrak²

2020

Yeni Üroloji Dergisi

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Üretra darlığının endoskopik cerrahisinde cold knife üretrotomi ile laser üretrotominin etkinliğini karşılaştırmayı amaçladık. Gereç ve Yöntemler: Toplam 171 hasta retrospektif olarak değerlerlendirildi. Çalışma kapsamında verileri tam olan 118 hasta 2 gruba ayrıldı (grup 1; n=53 cold knife üretrotomi, grup 2; n= 65 lazer üretrotomi). Darlığın uzunluğu, operasyon süresi, preoperatif ve postoperatif 3., 6. ve12. aylardaki Qmax değerleri, nüks olup olmadığı ve komplikasyon varlığı (kanama, extravazasyon, ateş gb) açısından iki grup karşılaştırıldı. Bulgular: Operasyon zamanının cold knife üretrotomi yapılan hastalarda daha kısa olduğu görüldü (14.01 ± 3.86 dk vs 25.03 ± 4.43 dk, p=0.001). Postoperatif 3., 6., ve 12. aylardaki Q max değerlerinin lazer üretrotomi yapılan hastalarda daha yüksek olduğu görüldü (p=0.03, p=0.001, p=0.001). Bir yıllık takip sonucunda grup-1' de 28 (52.83%) hastada nüks saptanırken, grup-2' de 12 (18.46%) hastada nüks geliştiği gözlendi (p=0.01). Postoperatif komplikasyonlar açısından her iki grup arasında istatiksel olarak anlamlı fark izlenmedi. (p=0.209). Sonuç: Yaptığımız bu çalışmada üretra darlığını endoskopik cerrahisinde, lazer üretrotomi tekniğinin, cold knife üretrotomiye göre yüksek Qmax değerlerine ve daha düşük nüks oranına sahip olması nedeniyle daha başarılı bir cerrahi yöntem olduğu saptanmıştır. Sonuçların prospektif, randomize çalışmalarla desteklenmesi gerekmektedir.

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Section: Discussionmentioning

confidence: 98%

Üretra darlığında endoskopik cerrahi; Bıçağa karşı lazer

Solakhan¹,

Bayrak²

2020

Yeni Üroloji Dergisi

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“…18 The numbers were too small, however, to justify post hoc subgroup analysis in the OPEN trial. Other investigators have trialled a number of drugs injected into the strictures area at the time of urethrotomy, including steroids 92 and mitomycin C, 93 but there is no robust evidence of benefit. 94 Another approach is to maintain luminal patency using an internal stent, but again there is no robust evidence of effectiveness.…”

Section: Statement and Interpretation Of Resultsmentioning

confidence: 99%

Open urethroplasty versus endoscopic urethrotomy for recurrent urethral stricture in men: the OPEN RCT

Pickard

Goulão

Carnell

et al. 2020

Health Technol Assess

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Background Men who suffer recurrence of bulbar urethral stricture have to decide between endoscopic urethrotomy and open urethroplasty to manage their urinary symptoms. Evidence of relative clinical effectiveness and cost-effectiveness is lacking. Objectives To assess benefit, harms and cost-effectiveness of open urethroplasty compared with endoscopic urethrotomy as treatment for recurrent urethral stricture in men. Design Parallel-group, open-label, patient-randomised trial of allocated intervention with 6-monthly follow-ups over 24 months. Target sample size was 210 participants providing outcome data. Participants, clinicians and local research staff could not be blinded to allocation. Central trial staff were blinded when needed. Setting UK NHS with recruitment from 38 hospital sites. Participants A total of 222 men requiring operative treatment for recurrence of bulbar urethral stricture who had received at least one previous intervention for stricture. Interventions A centralised randomisation system using random blocks allocated participants 1 : 1 to open urethroplasty (experimental group) or endoscopic urethrotomy (control group). Main outcome measures The primary clinical outcome was control of urinary symptoms. Cost-effectiveness was assessed by cost per quality-adjusted life-year (QALY) gained over 24 months. The main secondary outcome was the need for reintervention for stricture recurrence. Results The mean difference in the area under the curve of repeated measurement of voiding symptoms scored from 0 (no symptoms) to 24 (severe symptoms) between the two groups was –0.36 [95% confidence interval (CI) –1.78 to 1.02; p = 0.6]. Mean voiding symptom scores improved between baseline and 24 months after randomisation from 13.4 [standard deviation (SD) 4.5] to 6 (SD 5.5) for urethroplasty group and from 13.2 (SD 4.7) to 6.4 (SD 5.3) for urethrotomy. Reintervention was less frequent and occurred earlier in the urethroplasty group (hazard ratio 0.52, 95% CI 0.31 to 0.89; p = 0.02). There were two postoperative complications requiring reinterventions in the group that received urethroplasty and five, including one death from pulmonary embolism, in the group that received urethrotomy. Over 24 months, urethroplasty cost on average more than urethrotomy (cost difference £2148, 95% CI £689 to £3606) and resulted in a similar number of QALYs (QALY difference –0.01, 95% CI –0.17 to 0.14). Therefore, based on current evidence, urethrotomy is considered to be cost-effective. Limitations We were able to include only 69 (63%) of the 109 men allocated to urethroplasty and 90 (80%) of the 113 men allocated to urethrotomy in the primary complete-case intention-to-treat analysis. Conclusions The similar magnitude of symptom improvement seen for the two procedures over 24 months of follow-up shows that both provide effective symptom control. The lower likelihood of further intervention favours urethroplasty, but this had a higher cost over the 24 months of follow-up and was unlikely to be considered cost-effective. Future work Formulate methods to incorporate short-term disutility data into cost-effectiveness analysis. Survey pathways of care for men with urethral stricture, including the use of enhanced recovery after urethroplasty. Establish a pragmatic follow-up schedule to allow national audit of outcomes following urethral surgery with linkage to NHS Hospital Episode Statistics. Trial registration Current Controlled Trials ISRCTN98009168. Funding This project was funded by the NIHR Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 61. See the NIHR Journals Library website for further project information.

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“…In a very recent study conducted in 2018, patients who received 10 mg tamoxifen daily for six months after internal urethrotomy were compared with the control group, and tamoxifen was shown to significantly reduce re-fibrosis and stricture development. Again in 2016, in a study with 83 patients, Yıldırım et al 20 showed that recurrence is significantly lower in patients who received a local urethral steroid injection compared with a control. Sinanoglu et al 21 conducted a similar study with 84 patients and used colchicine as an anti-inflammatory agent, and the recurrence in this group was significantly lower.…”

Section: Discussionmentioning

confidence: 99%

Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?

Ürkmez

Topaktaş

Özsoy

et al. 2019

Rev. Assoc. Med. Bras.

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SUMMARY INTRODUCTION Due to spongiofibrosis and inflammatory processes underlying the pathogenesis of urethral stricture, it is possible that the neutrophil-lymphocyte ratio (NLR) may give essential information about the course of the disease and recurrence possibilities. Our study aims to evaluate the correlation between NLR and recurrence rates. METHODS A total of 512 patients who underwent direct visual internal urethrotomy (DVIU) due to urethral stricture in our clinic between February 2010 and January 2018 were evaluated retrospectively. RESULTS The median follow up for non-recurrent and recurrent groups after DVIU was 30 and 36 months, respectively. During the follow-up, 280 (54.7%) of the patients had recurrences, and 232 (45,3%) had no recurrences. The mean time for recurrence after DVIU was 6,5±1,4 months, with a range of 1-36 months. The mean NLR in the non-recurrence group was 2,02±0,87, with a median of 1.9, and 3,66±2,30, with a median of 3 in the recurrence group. A highly significant statistical difference was observed between two groups in terms of neutrophil count and NLR (p: 0.000 – both). The area under curve value for NLR was 0.767, with a standard error of 0.021 (95% CI 0.727-0.808). The cut-off value of NLR was determined as 2.25, with a 70% sensitivity and 67,7% specificity. CONCLUSION By using NLR, the inflammatory features of the urethral tissue can be predicted, and possible recurrences after surgery can be estimated. Consequently, open urethroplasty techniques can be used in cases with a significant NLR value instead of the recurrent endoscopic procedure.

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The effectiveness of local steroid injection after internal urethrotomy to avoid recurrence

Abstract: The use of local steroids with IU seems to decrease the high stricture recurrence rate following IU. When local steroids were administered with complementary intention, the disease control outcomes are encouraging. Further robust comparative effectiveness studies are now required.

Cited by 19 publications

References 25 publications

Üretra darlığında endoskopik cerrahi; Bıçağa karşı lazer

Üretra darlığında endoskopik cerrahi; Bıçağa karşı lazer

Open urethroplasty versus endoscopic urethrotomy for recurrent urethral stricture in men: the OPEN RCT

Is neutrophil to lymphocyte ratio a predictive factor for recurrence of urethral stricture?

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